Division of Orthopaedics, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium.
Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Louvain, Belgium.
Spine Deform. 2023 Sep;11(5):1137-1143. doi: 10.1007/s43390-023-00711-z. Epub 2023 Jun 7.
Treatment of AIS, a three-dimensional spinal (3D) deformity, is guided by a two-dimensional (2D) evaluation. Novel 3D approaches that address the 2D limitations have not been adopted in AIS care due to their lengthy and complex 3D reconstruction procedures. This study aims to introduce a simple 3D method that translates the 2D key parameters (Stable vertebra (SV), Lenke lumbar modifier, Neutral vertebra (NV)) into 3D and to quantitively compare these 3D corrected parameters to the 2D assessment.
The key parameters of 79 surgically treated Lenke 1 and 2 patients were measured in 2D by two experienced spine surgeons. Next, these key parameters were measured in 3D by indicating relevant landmarks on biplanar radiographs and using the 'true' 3D CSVL which was perpendicular to the pelvic plane. Differences between the 2D and 3D analysis were examined.
A 2D-3D mismatch was identified in 33/79 patients (41.8%) for at least one of the key parameters. More specifically, a 2D-3D mismatch was identified in 35.4% of patients for the Sag SV, 22.5% of patients for the SV and 17.7% of patients for the lumbar modifier. No differences in L4 tilt and NV rotation were found.
The findings highlight that a 3D evaluation alters the choice of the LIV in Lenke 1 and 2 AIS patients. Although, the true impact of this more precise 3D measurement on preventing poor radiographic outcome needs further investigation, the results are a first step toward establishing a basis for 3D assessments in daily practice.
脊柱侧凸（AIS）的治疗是基于二维（2D）评估的。由于三维（3D）重建过程冗长复杂，因此尚未采用新型的 3D 方法来解决 2D 的局限性。本研究旨在引入一种简单的 3D 方法，该方法将 2D 的关键参数（稳定椎（SV）、Lenke 腰椎修正值、中性椎（NV））转化为 3D，并对这些 3D 校正参数与 2D 评估进行定量比较。
由两位经验丰富的脊柱外科医生在 2D 平面上对 79 例经手术治疗的 Lenke 1 和 2 型患者的关键参数进行测量。接下来，通过在双平面 X 光片上标记相关标志并使用垂直于骨盆平面的“真实”3D CSVL，在 3D 平面上测量这些关键参数。检查了 2D 和 3D 分析之间的差异。
在至少一个关键参数上，33/79 例（41.8%）患者出现 2D-3D 不匹配。更具体地说，在 Sag SV 方面，35.4%的患者存在 2D-3D 不匹配；在 SV 方面，22.5%的患者存在 2D-3D 不匹配；在腰椎修正值方面，17.7%的患者存在 2D-3D 不匹配。未发现 L4 倾斜和 NV 旋转的差异。
研究结果表明，3D 评估改变了 Lenke 1 和 2 型 AIS 患者选择 LIV 的方式。尽管这种更精确的 3D 测量对预防不良影像学结果的实际影响需要进一步研究，但这些结果是在日常实践中建立 3D 评估基础的第一步。
