Almansour H, Pepke W, Rehm J, Bruckner T, Spira D, Akbar M
Department of Orthopedic Surgery, Trauma Surgery and Spinal Cord Injury, Heidelberg University, Schlierbacher Landstr. 200A, 69118, Heidelberg, Germany.
Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany.
Orthopade. 2020 Apr;49(4):350-358. doi: 10.1007/s00132-019-03712-x.
Bracing constitutes the mainstay treatment for mild scoliosis. The 3D reconstruction of the spine using low-dose stereoradiographic imaging (LSI) is increasingly being used to determine the true shape of the deformity and to assess the success of bracing.
The aim of the study was to validate the measurement of 3D spinopelvic parameters and vertebral rotation in the setting of bracing treatment via a reliability study conducted in adherence to the guidelines for reporting reliability and agreement studies (GRRAS).
Full spine stereoradiographs of patients with adolescent idiopathic scoliosis (AIS) who underwent Chêneau bracing were retrospectively analyzed. The 3D reconstruction was performed by two experienced operators in a blinded manner and randomized order. Rotation of every vertebra was computed in the coronal, sagittal and axial planes. Sagittal spinopelvic parameters were evaluated. All measurements were statistically compared to determine agreement of the measurement of brace correction using the intraclass correlation coefficient (ICC).
In this study, 45 patients (81% females) aged 12.5 ± 2 years were included. The mean absolute difference was less than 3.5° for all measured angles, less than 4 mm for sagittal vertical axis (SVA) and less than 1.5 mm for lateral pelvic shift. The ICC was high for all parameters (ICC >0.81). Despite the overall high reliability, the reliability of axial rotation was lower in the upper and middle thoracic spine and the lower lumbar spine.
Brace wearing during full spine LSI acquisition does not affect spinal measurements. The LSI under bracing treatment produces reliable measurements of spinopelvic parameters as well as vertebral rotation. These reproducible 3D data enable spine surgeons to assess the true shape of the deformity, to quantify rotation of each vertebra and enhance the understanding of the efficacy of bracing treatment.
支具治疗是轻度脊柱侧弯的主要治疗方法。利用低剂量立体放射成像（LSI）进行脊柱的三维重建越来越多地用于确定畸形的真实形态以及评估支具治疗的效果。
本研究的目的是通过一项遵循可靠性和一致性研究报告指南（GRRAS）进行的可靠性研究，验证在支具治疗情况下三维脊柱骨盆参数和椎体旋转的测量。
对接受施诺支具治疗的青少年特发性脊柱侧弯（AIS）患者的全脊柱立体放射照片进行回顾性分析。由两名经验丰富的操作人员以盲法和随机顺序进行三维重建。计算每个椎体在冠状面、矢状面和轴位平面的旋转情况。评估矢状面脊柱骨盆参数。对所有测量值进行统计学比较，以使用组内相关系数（ICC）确定支具矫正测量的一致性。
本研究纳入了45例年龄为12.5±2岁的患者（81%为女性）。所有测量角度的平均绝对差值小于3.5°，矢状垂直轴（SVA）小于4毫米，骨盆侧移小于1.5毫米。所有参数的ICC均较高（ICC>0.81）。尽管总体可靠性较高，但上中胸椎和下腰椎的轴向旋转可靠性较低。
在全脊柱LSI采集过程中佩戴支具不影响脊柱测量。支具治疗下的LSI能可靠地测量脊柱骨盆参数以及椎体旋转。这些可重复的三维数据使脊柱外科医生能够评估畸形的真实形态，量化每个椎体的旋转，并增强对支具治疗效果的理解。
