Department of Pediatric Orthopaedics, Robert Debré Hospital, Paris 7 University, AP-HP, 48 boulevard Sérurier, 75019, Paris, France.
Eur Spine J. 2018 Sep;27(9):2165-2174. doi: 10.1007/s00586-018-5591-3. Epub 2018 Apr 24.
Preoperative planning of scoliosis surgery is essential in the effective treatment of spine pathology. Thus, precontoured rods have been recently developed to avoid iatrogenic sagittal misalignment and rod breakage. Some specific issues exist in adolescent idiopathic scoliosis (AIS), such as a less distal lower instrumented level, a great variability in the location of inflection point (transition from lumbar lordosis to thoracic kyphosis), and sagittal correction is limited by both bone-implant interface. Since 2007, stereoradiographic imaging system is used and allows for 3D reconstructions. Therefore, a software was developed to perform preoperative 3D surgical planning and to provide rod's shape and length. The goal of this preliminary study was to assess the feasibility, reliability, and the clinical relevance of this new software.
Retrospective study on 47 AIS patients operated with the same surgical technique: posteromedial translation through posterior approach with lumbar screws and thoracic sublaminar bands. Pre- and postoperatively, 3D reconstructions were performed on stereoradiographic images (EOS system, Paris, France) and compared. Then, the software was used to plan the surgical correction and determine rod's shape and length. Simulated spine and rods were compared to postoperative real 3D reconstructions. 3D reconstructions and planning were performed by an independent observer.
3D simulations were performed on the 47 patients. No difference was found between the simulated model and the postoperative 3D reconstructions in terms of sagittal parameters. Postoperatively, 21% of LL were not within reference values. Postoperative SVA was 20 mm anterior in 2/3 of the cases. Postoperative rods were significantly longer than precontoured rods planned with the software (mean 10 mm). Inflection points were different on the rods used and the planned rods (2.3 levels on average).
In this preliminary study, the software based on 3D stereoradiography low-dose system used to plan AIS surgery seems reliable for preoperative planning and precontoured rods. It is an interesting tool to improve surgeons' practice, since 3D planning is expected to reduce complications such as iatrogenic malalignment and to help for a better understanding of the complications, choosing the location of the transitional vertebra. However, further work is needed to improve thoracic kyphosis planning. These slides can be retrieved under Electronic Supplementary Material.
脊柱病变的有效治疗需要术前规划，因此最近开发了预成型棒以避免医源性矢状面失平衡和棒断裂。青少年特发性脊柱侧凸（AIS）存在一些特殊问题，例如下固定节段较短，拐点位置变化较大（从腰椎前凸到胸椎后凸的过渡），并且矢状面矫正受到骨-植入物界面的限制。自 2007 年以来，立体放射成像系统得到了应用，并可以进行 3D 重建。因此，开发了一种软件来进行术前 3D 手术规划，并提供棒的形状和长度。本初步研究的目的是评估这种新软件的可行性、可靠性和临床相关性。
对采用相同手术技术（后路经后正中入路腰椎螺钉和胸椎椎板下带）治疗的 47 例 AIS 患者进行回顾性研究。术前和术后均在立体放射成像（EOS 系统，法国巴黎）上进行 3D 重建，并进行比较。然后，使用该软件规划手术矫正并确定棒的形状和长度。模拟脊柱和棒与术后真实 3D 重建进行比较。3D 重建和规划由独立观察者进行。
对 47 例患者进行了 3D 模拟。在矢状面参数方面，模拟模型与术后 3D 重建之间没有差异。术后，21%的 LL 值不在参考范围内。术后 SVA 在前 2/3 的病例中为 20mm。术后使用的棒明显长于软件规划的预成型棒（平均长 10mm）。实际使用的棒和规划的棒的拐点不同（平均 2.3 个节段）。
在这项初步研究中，基于低剂量 3D 立体放射成像系统的软件用于 AIS 手术的术前规划和预成型棒似乎是可靠的。它是一种提高外科医生实践水平的有趣工具，因为 3D 规划有望减少医源性失平衡等并发症，并有助于更好地理解并发症，选择过渡椎体的位置。然而，需要进一步的工作来改进胸椎后凸的规划。这些幻灯片可以在电子补充材料中找到。
