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Does use of pre-operative low-dose CT-scan in adolescent idiopathic scoliosis improve accuracy in screw placement? Results of a retrospective study

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Abstract

Purpose

To evaluate the efficacy of pre-operative low-dose radiation computed tomography (CT) in optimizing screw placement in patients with adolescent idiopathic scoliosis (AIS).

Methods

49 patients with AIS who required correction and posterior fusion between January 2018 and December 2019 were included in this retrospective study. All patients underwent surgery performed by the same team of experienced surgeons. Patients were divided in two groups. The study group received a pre-operative low-dose CT scan (CT group, n = 25), differently from the control group (CG, n = 24). Patients of both groups received a post-operative low-dose CT scan. The primary outcome measure was the accuracy of screw placement on the Gertzbein–Robbins scale (grades A and B were considered acceptable). Secondary outcome measures included a comparison of perioperative complications.

Results

A total of 1045 screws were placed. In CT group (n = 25, screws = 528) and CG (n = 24, screws = 517), trajectories were grade A or B in 94.5% and 93.6% of screws, respectively. Two screws (one for each group) were removed because of intra-operative-evoked potentials alteration and one screw required revision after post-operative imaging. No correlation was found between the malpositioning rate and the proximity to the apex of the curve, conversely a significative peak of misplacements was observed at T3 (p < 0.01). No neurological and vascular complications related to screw placement were recorded. There was not intergroup difference neither in screw accuracy (Chi-Square, 2-tailed Fisher’s exact, p = 0.63), nor in complications rate.

Conclusion

Pre-operative low-dose CT scan as surgical plan does not contribute in reducing pedicle screw misplacement rate.

Study design

Retrospective comparative cohort study.

Level of evidence

III.

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Availability of data and material

Data are available on PACS (Picture archiving and communication system) of our Institute.

References

  1. Halm H, Niemeyer T, Link T, Liljenqvist U (2000) Segmental pedicle screw instrumentation in idiopathic thoracolumbar and lumbar scoliosis. Eur Spine J 9(3):191–197

    Article  CAS  Google Scholar 

  2. Hamill CL, Lenke LG, Bridwell KH, Chapman MP, Blanke K, Baldus C (1996) The use of pedicle screw fixation to improve correction in the lumbar spine of patients with idiopathic scoliosis. Is it warranted? Spine (Phila Pa 1976) 21(10):1241–1249

    Article  CAS  Google Scholar 

  3. Suk SI, Lee CK, Kim WJ, Chung YJ, Park YB (1995) Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine (Phila Pa 1976) 20(12):1399–1405

    Article  CAS  Google Scholar 

  4. Bartley CE, Yaszay B, Bastrom TP, Shah SA, Lonner BS, Asghar J, Miyanji F, Samdani A, Newton PO (2017) Perioperative and delayed major complications following surgical treatment of adolescent idiopathic scoliosis. J Bone Joint Surg Am 99(14):1206–1212

    Article  Google Scholar 

  5. Kwan MK, Chiu CK, Gani SM, Wei CC (2017) Accuracy and safety of pedicle screw placement in adolescent idiopathic scoliosis patients: a review of 2020 screws using computed tomography assessment. Spine (Phila Pa 1976) 42(5):326–335

    Article  Google Scholar 

  6. Sarwahi V, Sugarman EP, Wollowick AL, Amaral TD, Lo Y, Thornhill B (2014) Prevalence, distribution, and surgical relevance of abnormal pedicles in spines with adolescent idiopathic scoliosis vs. no deformity: a CT-based study. J Bone Joint Surg Am 96(11):e92

    Article  Google Scholar 

  7. Gao B, Gao W, Chen C, Wang Q, Lin S, Xu C, Huang D, Su P (2017) What is the difference in morphologic features of the thoracic pedicle between patients with adolescent idiopathic scoliosis and healthy subjects? A CT-based case-control study. Clin Orthop Relat Res 475(11):2765–2774

    Article  Google Scholar 

  8. Jamieson D, Perdios A, Varghese R, Reilly CW (2008) The use of CT in the development and implementation of a preoperative protocol to aid in pedicle screw placement during scoliosis surgery. Pediatr Radiol 38(4):452–456

    Article  Google Scholar 

  9. Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83(8):1169–1181

    Article  CAS  Google Scholar 

  10. Shen M, Jiang H, Luo M, Wang W, Li N, Wang L, Xia L (2017) Comparison of low density and high density pedicle screw instrumentation in Lenke 1 adolescent idiopathic scoliosis. BMC Musculoskelet Disord 18(1):336

    Article  Google Scholar 

  11. Faldini C, Perna F, Geraci G, Pardo F, Mazzotti A, Pilla F, Ruffilli A (2018) Triplanar correction of adolescent idiopathic scoliosis by asymmetrically shaped and simultaneously applied rods associated with direct vertebral rotation: clinical and radiological analysis of 36 patients. Eur Spine J 27(Suppl 2):165–174

    Article  Google Scholar 

  12. Schatlo B, Molliqaj G, Cuvinciuc V, Kotowski M, Schaller K, Tessitore E (2014) Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison. J Neurosurg Spine 20(6):636–643

    Article  Google Scholar 

  13. Miyazaki M, Ishihara T, Kanezaki S, Notani N, Abe T, Tsumura H (2018) Relationship between vertebral morphology and the potential risk of spinal cord injury by pedicle screw in adolescent idiopathic scoliosis. Clin Neurol Neurosurg 172:143–150

    Article  Google Scholar 

  14. Zhang W, Takigawa T, Wu Y, Sugimoto Y, Tanaka M, Ozaki T (2017) Accuracy of pedicle screw insertion in posterior scoliosis surgery: a comparison between intraoperative navigation and preoperative navigation techniques. Eur Spine J 26(6):1756–1764

    Article  Google Scholar 

  15. Abul-Kasim K, Strömbeck A, Ohlin A, Maly P, Sundgren PC (2009) Reliability of low-radiation dose CT in the assessment of screw placement after posterior scoliosis surgery, evaluated with a new grading system. Spine (Phila Pa 1976) 34(9):941–948

    Article  Google Scholar 

  16. Hicks JM, Singla A, Shen FH, Arlet V (2010) Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine (Phila Pa 1976) 35(11):E465-470

    Article  Google Scholar 

  17. Di Silvestre M, Parisini P, Lolli F, Bakaloudis G (2007) Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976) 32(15):1655–1661

    Article  Google Scholar 

  18. Vaccaro AR, Rizzolo SJ, Balderston RA, Allardyce TJ, Garfin SR, Dolinskas C, An HS (1995) Placement of pedicle screws in the thoracic spine. Part II: An anatomical and radiographic assessment. J Bone Joint Surg Am 77(8):1200–1206

    Article  CAS  Google Scholar 

  19. 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 (Phila Pa 1976) 37(17):E1054-1061

    Article  Google Scholar 

  20. 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(4):E103-107

    Article  Google Scholar 

  21. Wang X, Larson AN, Crandall DG, Parent S, Labelle H, Ledonio CGT, Aubin CE (2017) Biomechanical effect of pedicle screw distribution in AIS instrumentation using a segmental translation technique: computer modeling and simulation. Scoliosis Spinal Disord 12:13

    Article  Google Scholar 

  22. Tambe AD, Panikkar SJ, Millner PA, Tsirikos AI (2018) Current concepts in the surgical management of adolescent idiopathic scoliosis. Bone Joint J 100-b(4):415–424

    Article  CAS  Google Scholar 

  23. Abe Y, Ito M, Abumi K, Sudo H, Salmingo R, Tadano S (2015) Scoliosis corrective force estimation from the implanted rod deformation using 3D-FEM analysis. Scoliosis 10(Suppl 2):S2

    Article  Google Scholar 

  24. Larson AN, Polly DW Jr, Diamond B, Ledonio C, Richards BS 3rd, Emans JB, Sucato DJ, Johnston CE (2014) Does higher anchor density result in increased curve correction and improved clinical outcomes in adolescent idiopathic scoliosis? Spine (Phila Pa 1976) 39(7):571–578

    Article  Google Scholar 

  25. Rushton PR, Elmalky M, Tikoo A, Basu S, Cole AA, Grevitt MP (2016) The effect of metal density in thoracic adolescent idiopathic scoliosis. Eur Spine J 25(10):3324–3330

    Article  Google Scholar 

  26. Newton PO, Wu KW, Bastrom TP, Bartley CE, Upasani VV, Yaszay B (2019) What factors are associated with kyphosis restoration in lordotic adolescent idiopathic scoliosis patients? Spine Deform 7(4):596–601

    Article  Google Scholar 

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Funding

No funding was received for this study by National Institutes of Health (NIH), Wellcome Trust, Howard Hughes Medical Institute (HHMI) or others.

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Contributions

AR: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work, yes; drafted the work or revised it critically for important intellectual content, yes; approved the version to be published, yes; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, yes; type of principal contribution, conception, data interpretation and revision. MF: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work, yes; drafted the work or revised it critically for important intellectual content, yes;approved the version to be published, yes; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, yes; type of principal contribution, conception and writing. MK: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work, yes; drafted the work or revised it critically for important intellectual content, yes;approved the version to be published, yes; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, yes; type of principal contribution, conception and revision. FB: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work, yes; drafted the work or revised it critically for important intellectual content, yes;approved the version to be published, yes; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, yes;Type of principal contribution, Data collection and writing. SP: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work, yes; drafted the work or revised it critically for important intellectual content, yes;approved the version to be published, yes; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, yes;type of principal contribution, data collection and writing. MB: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work, yes; drafted the work or revised it critically for important intellectual content, yes;approved the version to be published, yes; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, yes;Type of principal contribution, Data collection and writing. TG: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work, yes; drafted the work or revised it critically for important intellectual content, yes;approved the version to be published, yes; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, yes; type of principal contribution, supervision and data interpretation. CF: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work, yes; drafted the work or revised it critically for important intellectual content, yes;approved the version to be published, yes; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, yes; type of principal contribution, supervision and data interpretation.

Corresponding author

Correspondence to Michele Fiore.

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Authors have no conflicts of interest to declare.

Ethics approval

The study was approved by the institutional review board of our hospital.

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Ruffilli, A., Fiore, M., Martikos, K. et al. Does use of pre-operative low-dose CT-scan in adolescent idiopathic scoliosis improve accuracy in screw placement? Results of a retrospective study. Spine Deform 9, 1403–1410 (2021). https://doi.org/10.1007/s43390-021-00343-1

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