Ramchandran Subaraman, Monsour Ali, Mihas Alexander, George Kevin, Errico Thomas, George Stephen
Center for Spinal Disorders, Nicklaus Children's Hospital, Miami, FL, USA.
Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA.
Global Spine J. 2022 Oct;12(8):1731-1735. doi: 10.1177/2192568220988271. Epub 2021 Jan 28.
Retrospective cohort study.
The purpose of the study is to evaluate the role of supine radiographs in determining flexibility of thoracic and thoracolumbar curves.
Ninety operative AIS patients with 2-year follow-up from a single institution were queried and classified into MT structural and TL structural groups. Equations were derived using linear regression to compute cut-off values for MT and TL curves. Thresholds were externally validated in a separate database of 60 AIS patients, and positive and negative predictive values were determined for each curve.
MT supine values were highly predictive of MT side-bending values (TL group: 0.63, < 0.001; MT group: 0.66, = 0.006). Similarly, TL supine values were highly predictive of TL side-bending values (TL group: 0.56, = 0.001 MT group: 0.68, = 0.001). From our derived equations, MT and TL curves were considered structural on supine films if they were ≥ 30° and 35°, respectively. Contingency table analysis of external validity sample showed that supine films were highly predictive of structurality of MT curve (Sensitivity = 0.91, PPV = 0.95, NPV = 0.81) and TL curve (Sensitivity = 0.77, PPV = 0.81, NPV = 0.94). ROC analysis revealed that the area under curve for MT structurality from supine films was 0.931 (SEM: 0.03, CI: 0.86-0.99, < 0.001) and TL structurality from supine films was 0.922 (SEM: 0.03, CI- 0.84-0.98, < 0.001).
A single preoperative supine radiograph is highly predictive of side-bending radiographs to assess curve flexibility in AIS. A cut-off of ≥ 30° for MT and ≥ 35° for TL curves in supine radiographs can determine curve structurality.
回顾性队列研究。
本研究旨在评估仰卧位X线片在确定胸段及胸腰段脊柱侧凸柔韧性方面的作用。
对来自单一机构的90例接受手术治疗的青少年特发性脊柱侧凸（AIS）患者进行为期2年的随访，并将其分为胸段结构性和胸腰段结构性两组。通过线性回归得出方程，计算胸段和胸腰段曲线的临界值。在另一个包含60例AIS患者的数据库中对这些临界值进行外部验证，并确定每条曲线的阳性预测值和阴性预测值。
胸段仰卧位测量值对胸段侧屈测量值具有高度预测性（胸腰段组：0.63，P<0.001；胸段组：0.66，P = 0.006）。同样，胸腰段仰卧位测量值对胸腰段侧屈测量值也具有高度预测性（胸腰段组：0.56，P = 0.001；胸段组：0.68，P = 0.001）。根据我们推导的方程，仰卧位X线片上胸段和胸腰段曲线若分别≥30°和35°，则被认为是结构性的。对外部验证样本进行列联表分析显示，仰卧位X线片对胸段曲线结构性具有高度预测性（敏感性 = 0.91，阳性预测值 = 0.95，阴性预测值 = 0.81）和胸腰段曲线结构性（敏感性 = 0.77，阳性预测值 = 0.81，阴性预测值 = 0.94）。ROC分析显示，仰卧位X线片对胸段曲线结构性的曲线下面积为0.931（标准误：0.03，95%置信区间：0.86 - 0.99，P<0.001），对胸腰段曲线结构性的曲线下面积为0.922（标准误：0.03，95%置信区间：0.84 - 0.98，P<0.001）。
术前单次仰卧位X线片对评估AIS患者脊柱侧凸柔韧性的侧屈X线片具有高度预测性。仰卧位X线片中胸段曲线≥30°、胸腰段曲线≥35°的临界值可确定曲线的结构性。
