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3D analysis of the preoperative deformity in AIS can be used to guide surgical treatment decisions for selective thoracic fusion

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Abstract

Purpose

To identify 3D measures of scoliosis from preoperative imaging that are associated with optimal radiographic outcomes after selective thoracic fusion (STF) for adolescent idiopathic scoliosis (AIS).

Methods

Subjects with primary thoracic curves (Lenke 1–4, B or C modifiers) fused selectively (L1 or above) who had preoperative 3D reconstructions and minimum 2 years of follow-up were included. An optimal outcome at 2 years was defined as having 4 of 5 parameters previously defined in the literature: (1) lumbar curve < 26º, (2) deformity flexibility quotient < 4, (3) C7-CSVL < 2 cm, (4) lumbar prominence < 5º and (5) trunk shift < 1.5 cm. Univariate and CART analyses were performed to identify preoperative variables associated with achieving an optimal outcome 2 years postoperatively.

Results

Ninety-nine (88F, 11 M) patients met inclusion. Mean age was 15 ± 2 years. Fifty-one subjects (52%) had an optimal outcome. Seven preoperative deformity measures representing smaller thoracolumbar/lumbar deformity in the optimal group were found to be significant on univariate analysis. CART analysis identified the following variables associated with optimal outcomes: difference in apical rotation > 30° = 27% optimal outcomes, difference in apical rotation ≤ 30° and coronal vertebral wedging of lumbar apex > 3° = 46% optimal outcomes, and difference in apical rotation ≤ 30° and coronal vertebral wedging of lumbar apex ≤ 3° = 80% optimal outcomes (p < 0.05).

Conclusion

Optimal outcomes after STF were associated with a preoperative difference in apical vertebral rotation in the axial plane less than 30° between thoracic and lumbar curves as well as coronal plane vertebral wedging of the lumbar apical vertebra less than 3°.

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Funding

This study was supported in part by grants to the Setting Scoliosis Straight Foundation in support of Harms Study Group research from DePuy, Synthes, EOS Imaging/Alphatech, Stryker Spine, Medtronic, NuVasive, Zimmer Biomet, and the Food and Drug Administration.

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Authors and Affiliations

  1. Division of Orthopedics and Scoliosis, Rady Children’s Hospital, 3020 Children’s Way, MC 5062, San Diego, CA, 92123, USA

    Vidyadhar V. Upasani, Carrie E. Bartley, Tracey P. Bastrom, Michael P. Kelly & Peter O. Newton

  2. Department of Orthopedics, University of California, San Diego, CA, USA

    Vidyadhar V. Upasani, Michael P. Kelly & Peter O. Newton

  3. 3Department of Orthopedics, Nicklaus Children’s Hospital, Miami, FL, USA

    Stephen George

  4. Department of Orthopaedics, CHU Sainte-Justine, Montreal, Québec, Canada

    Stefan Parent

  5. Department of Surgery, University of Montreal, Montréal, Québec, Canada

    Stefan Parent

Authors
  1. Vidyadhar V. Upasani
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  2. Carrie E. Bartley
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  3. Tracey P. Bastrom
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  4. Stephen George
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  5. Stefan Parent
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  6. Michael P. Kelly
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  7. Peter O. Newton
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Corresponding author

Correspondence to Vidyadhar V. Upasani.

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This study was conducted at Rady Children’s Hospital, San Diego, CA, USA.

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Upasani, V.V., Bartley, C.E., Bastrom, T.P. et al. 3D analysis of the preoperative deformity in AIS can be used to guide surgical treatment decisions for selective thoracic fusion. Spine Deform 12, 717–725 (2024). https://doi.org/10.1007/s43390-024-00827-w

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  • DOI: https://doi.org/10.1007/s43390-024-00827-w

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