Pediatric Orthopaedic Department, Purpan University Hospital, Toulouse, France; Institut de Mécanique des Fluides de Toulouse UMR CNRS 5502, Toulouse, France.
Institut de Mécanique des Fluides de Toulouse UMR CNRS 5502, Toulouse, France.
Orthop Traumatol Surg Res. 2022 Oct;108(6):103350. doi: 10.1016/j.otsr.2022.103350. Epub 2022 Jun 16.
Determining which spinal levels to instrument during surgical treatment of Lenke Type 1 adolescent idiopathic scoliosis (AIS) depends on the reducibility of the primary and secondary curve patterns. This reducibility can be evaluated in several ways, with the most popular being radiographs in bending for moderate thoracic and lumbar curvatures. Hypothesis Side-bending radiographs will alter the choice of the lowest instrumented vertebra (LIV) for the surgical treatment of AIS.
Thirteen experienced French spine surgeons were invited to perform surgical planning on 23 patients based on stereoradiographs with and without (standing) side-bending views. The surgical planning was repeated a second time to assess the intra- and inter-rater reliability. Variations in the choice of LIV were analyzed for each evaluation.
The intra-rater reliability was moderate to substantial. The inter-rater reliability was low to moderate. The study compared 879 surgical plans. Selective fusion was chosen in 0.3% of the plans. The median LIV was L2. The availability of side bending views changed the plan in 39% of cases. However, 36% of the plans were changed in the control (test-retest) condition. No significant difference was found between the variations with side-bending radiographs and "control" variations (p>0.05).
The use of radiographs in bending has no significant effect on the LIV choice in this study. This result is derived from statistically robust analysis made possible by one of the largest datasets available on this topic. Large inter-rater variability was observed and will be explored further in a future study.
II; non-randomized controlled comparative study.
在手术治疗 Lenke 1 型青少年特发性脊柱侧凸（AIS）时，确定需要进行器械固定的脊柱节段取决于主弯和次弯的可矫正性。这种可矫正性可以通过多种方式进行评估，其中最常用的方法是对中胸段和胸腰段的中度弯曲进行弯曲位 X 线片检查。假设在手术治疗 AIS 时，侧位弯曲位 X 线片会改变选择最低固定节段（LIV）的方式。
邀请 13 位法国经验丰富的脊柱外科医生根据有和没有（站立）侧位弯曲位的立体放射片对 23 名患者进行手术规划。重复进行第二次手术规划评估以评估内部和内部评估者之间的可靠性。分析了每次评估中 LIV 选择的变化。
内部评估者之间的可靠性为中度到高度。评估者之间的可靠性为低到中度。本研究比较了 879 份手术计划。选择融合的方案在 0.3%的计划中。中位数 LIV 为 L2。有侧位弯曲位的情况下，39%的计划发生改变。但是，在对照（测试-重测）条件下，36%的计划发生了改变。在有侧位弯曲位和“对照”变化的情况下，没有发现显著差异（p>0.05）。
在本研究中，使用弯曲位 X 线片对 LIV 选择没有显著影响。这一结果是基于对该主题可用的最大数据集之一进行的统计上稳健的分析得出的。观察到评估者之间存在较大的变异性，将在未来的研究中进一步探讨。
II；非随机对照比较研究。
