Yee Nicholas J, Iorio Carlo, Shkumat Nicholas, Rocos Brett, Lebel David, Camp Mark
Division of Orthopaedic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Spine Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
J Pediatr Orthop. 2025 Jan 1;45(1):e43-e48. doi: 10.1097/BPO.0000000000002786. Epub 2024 Aug 22.
Children with neuromuscular scoliosis undergoing scoliosis surgery face substantial rates of complications. To mitigate surgical risks such as blood loss in pediatric patients with neuromuscular scoliosis, this study focuses on enabling instrumentation planning for their abnormal vertebral and pelvic anatomy and osteopenia. This study assessed the feasibility of an "ultralow-dose" CT (ULD CT) protocol without sedation in pediatric patients with neuromuscular scoliosis who often have comorbid movement disorders. Our prospective quality improvement study aims: (1) to determine if ULD CT without sedation is feasible in this patient group; (2) to quantify the radiation dose from ULD CT and compare it with preoperative spine radiographs (XR); and (3) to assess if ULD CT allows accurate anatomical assessment and intraoperative navigation given the prevalence of movement disorders.
Children with neuromuscular scoliosis underwent spine XR and ULD CT scans. Chart reviews assessed disease etiology and comorbidities. Radiation dose was quantified through Monte-Carlo simulations giving dose indices and effective dose, with statistical analysis done using a paired student's t -test (α=0.05). CT image quality was assessed for its use in preoperative planning and intraoperative navigation.
Fourteen patients (5 males, 9 females, average age 14±3 y) participated. One patient needed sedation due to autism spectrum disorder and global developmental delay. The radiation dose for spine XR was 0.5±0.2 mSv, and ULD CT was 0.6±0.1 mSv. There was no statistically significant difference in radiation doses between methods. All ULD CT scans had adequate quality for preoperative assessment of pedicle diameter and orientation, obstacles impeding pedicle entry, S2 Alar-Iliac screw orientation, and intraoperative navigation.
ULD CT without sedation is feasible for children with neuromuscular scoliosis. Radiation doses were comparable to standard radiographs. ULD CT provided accurate anatomical assessments and supported intraoperative navigation, proving beneficial despite movement disorders in these patients.
Level 2-Development of diagnostic criteria on basis of consecutive patients (with universally applied reference widely accepted standard).
接受脊柱侧弯手术的神经肌肉型脊柱侧弯患儿面临较高的并发症发生率。为降低小儿神经肌肉型脊柱侧弯患者手术风险，如失血风险，本研究致力于针对其异常的脊柱和骨盆解剖结构及骨质减少情况进行器械规划。本研究评估了在常伴有运动障碍的小儿神经肌肉型脊柱侧弯患者中使用无镇静“超低剂量”CT（ULD CT）方案的可行性。我们的前瞻性质量改进研究旨在：（1）确定无镇静的ULD CT在该患者群体中是否可行；（2）量化ULD CT的辐射剂量并与术前脊柱X线片（XR）进行比较；（3）鉴于运动障碍的普遍性，评估ULD CT是否能进行准确的解剖评估和术中导航。
神经肌肉型脊柱侧弯患儿接受了脊柱XR和ULD CT扫描。病历回顾评估了疾病病因和合并症。通过蒙特卡洛模拟量化辐射剂量，得出剂量指数和有效剂量，并使用配对学生t检验（α = 0.05）进行统计分析。评估CT图像质量在术前规划和术中导航中的应用。
14例患者（5例男性，9例女性；平均年龄14±3岁）参与研究。1例因自闭症谱系障碍和全面发育迟缓需要镇静。脊柱XR的辐射剂量为0.5±0.2 mSv，ULD CT为0.6±0.1 mSv。两种方法的辐射剂量无统计学显著差异。所有ULD CT扫描对于术前评估椎弓根直径和方向、阻碍椎弓根置入的障碍物、S2翼状髂骨螺钉方向以及术中导航均具有足够的质量。
无镇静的ULD CT对小儿神经肌肉型脊柱侧弯患者可行。辐射剂量与标准X线片相当。ULD CT提供了准确的解剖评估并支持术中导航，证明尽管这些患者存在运动障碍，但仍有益处。
2级——基于连续患者制定诊断标准（具有广泛应用的普遍接受的参考标准）。
