Abstract
Study Design
Cross-sectional.
Objectives
To quantify the asymmetry of the vertebral bodies and pedicles in the true transverse plane in adolescent idiopathic scoliosis (AIS) and to compare this with normal anatomy.
Summary of background data
There is an ongoing debate about the existence and magnitude of the vertebral body and pedicle asymmetry in AIS and whether this is an expression of a primary growth disturbance, or secondary to asymmetrical loading.
Methods
Vertebral body asymmetry, defined as left-right overlap of the vertebral endplates (ie, 100%: perfect symmetry, 0%: complete asymmetry) was evaluated in the true transverse plane on CT scans of 77 AIS patients and 32 non-scoliotic controls. Additionally, the pedicle width, length, and angle and the length of the ideal screw trajectory were calculated.
Results
Scoliotic vertebrae were on average more asymmetric than controls (thoracic: AIS 96.0% vs. controls 96.4%; p =.005, lumbar: 95.8% vs. 97.2%; p <.001) and more pronounced around the thoracic apex (95.8%) than at the end vertebrae (96.3%; p =.031). In the thoracic apex; the concave pedicle was thinner (4.5 vs. 5.4 mm; p <.001) and longer (20.9 vs. 17.9 mm; p <.001), the length of the ideal screw trajectory was longer (43.0 vs. 37.3 mm; p <.001), and the transverse pedicle angle was greater (12.3° vs. 5.7°; p <.001) than the convex one. The axial rotation showed no clear correlation with the asymmetry.
Conclusions
Even in non-scoliotic controls is a degree of vertebral body and pedicle asymmetry, but scoliotic vertebrae showed slightly more asymmetry, mostly around the thoracic apex. In contrast to the existing literature, there is no major asymmetry in the true transverse plane in AIS and no uniform relation between the axial rotation and vertebral asymmetry could be observed in these moderate to severe patients, suggesting that asymmetrical vertebral growth does not initiate rotation, but rather follows it as a secondary phenomenon.
Level of Evidence
Level 4.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Abbreviations
- 3-D:
-
three-dimensional
- AIS:
-
adolescent idiopathic scoliosis
- CT:
-
computed tomographic
- ICC:
-
intraclass correlation coefficients
- MANOVA:
-
multiple analysis of variances
- NCJ:
-
Neurocentral junctions
- r:
-
Pearson correlation coefficient
References
Adams W. Lateral curvature of the spine, external characters and morbid anatomy (lecture 4). Lectures on the pathology and treatment of lateral and other forms of curvature of the spine. London: Churchill; 1882. p. 69–93.
Albert E. Zur anatomie der skoliose. Wiener klinische Rundschau 1895;33:513–5.
Nicoladoni C. Anatomie und mechanismus der skoliose. In: Kocher ET, König FJ, von Mikulicz J, editors. Bibliotheca medica. Stuttgart, Germany: Verlag von erwin nagele; 1904.
Von Meyer H. Die mechanik der skoliose. Ein beitrag zur lehre von den missgestaltungen des knochengerüstes. Virchows Arch 1866;2:225–53.
Somerville EW. Rotational lordosis; the development of single curve. J Bone Joint Surg Br 1952;34–B:421–7.
Roaf R. The basic anatomy of scoliosis. J Bone Joint Surg Br 1966;48:786–92.
Schlosser TP, van Stralen M, Brink RC, et al. Three-dimensional characterization of torsion and asymmetry of the intervertebral discs versus vertebral bodies in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2014;39:E1159–66.
Liljenqvist UR, Link TM, Halm HF. Morphometric analysis of thoracic and lumbar vertebrae in idiopathic scoliosis. Spine (Phila Pa 1976) 2000;25:1247–53.
Schlosser TP, Vincken KL, Attrach H, et al. Quantitative analysis of the closure pattern of the neurocentral junction as related to preexistent rotation in the normal immature spine. Spine J 2013;13:756–63.
Parent S, Labelle H, Skalli W, et al. Thoracic pedicle morphometry in vertebrae from scoliotic spines. Spine (Phila Pa 1976) 2004;29:239–48.
Chu WC, Yeung HY, Chau WW, et al. Changes in vertebral neural arch morphometry and functional tethering of spinal cord in adolescent idiopathic scoliosis—study with multi-planar reformat magnetic resonance imaging. Stud Health Technol Inform 2006;123:27–33.
Rajwani T, Bagnall KM, Lambert R, et al. Using magnetic resonance imaging to characterize pedicle asymmetry in both normal patients and patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2004;29:E145–52.
Sarwahi V, Sugarman EP, Wollowick AL, et al. Prevalence, distribution, and surgical relevance of abnormal pedicles in spines with adolescent idiopathic scoliosis vs. no deformity: a CT-based study. J Bone Joint Surg Am 2014;96:e92.
Beguiristain JL, De Salis J, Oriaifo A, Canadell J. Experimental scoliosis by epiphysiodesis in pigs. Int Orthop 1980;3:317–21.
Canadell J, Beguiristain JL, Gonzalez Iturri J, et al. Some aspects of experimental scoliosis. Arch Orthop Trauma Surg 1978;93:75–85.
Kouwenhoven JW, Vincken KL, Bartels LW, et al. Analysis of preexistent vertebral rotation in the normal spine. Spine (Phila Pa 1976) 2006;31:1467–72.
Cui G, Watanabe K, Hosogane N, et al. Morphologic evaluation of the thoracic vertebrae for safe free-hand pedicle screw placement in adolescent idiopathic scoliosis: a CT-based anatomical study. Surg Radiol Anat 2012;34:209–16.
Watanabe K, Lenke LG, Matsumoto M, et al. A novel pedicle channel classification describing osseous anatomy: How many thoracic scoliotic pedicles have cancellous channels? Spine (Phila Pa 1976) 2010;35:1836–42.
Lenke LG, Edwards 2nd CC, Bridwell KH. The Lenke classification of adolescent idiopathic scoliosis: how it organizes curve patterns as a template to perform selective fusions of the spine. Spine (Phila Pa 1976) 2003;28:S199–207.
Cobb J. Outline for the study of scoliosis. In: Instructional Course Lectures. 2nd ed., 5. The American Academy of Orthopaedic Surgeons, Ann Arbor; 1948. p. 261.
Risser JC. The iliac apophysis: an invaluable sign in the management of scoliosis. Clin Orthop 1958;11:111–9.
Abul-Kasim K, Ohlin A. Patients with adolescent idiopathic scoliosis of Lenke type-1 curve exhibit specific pedicle width pattern. Eur Spine J 2012;21:57–63.
Volkmann R. Beiträge zur anatomie und chirurgie der geschwülste. Langenbecks Arch Chir 1873;15:556–61.
Hueter C. Anatomische studien an den extremitätengelenken neugeborener und erwachsener. Virchows Arch 1862;26:484–519.
Roaf R. Vertebral growth and its mechanical control. J Bone Joint Surg Br 1960;42–B:40–59.
Knutsson F. A contribution to the discussion of the biological cause of idiopathic scoliosis. Acta Orthop Scand 1963;33:98–104.
Taylor JR. Scoliosis and growth. patterns of asymmetry in normal vertebral growth. Acta Orthop Scand 1983;54:596–602.
Rajwani T, Bhargava R, Moreau M, et al. MRI characteristics of the neurocentral synchondrosis. Pediatr Radiol 2002;32:811–6.
Takeshita K, Maruyama T, Chikuda H, et al. Diameter, length, and direction of pedicle screws for scoliotic spine: analysis by multiplanar reconstruction of computed tomography. Spine (Phila Pa 1976) 2009;34(8):798–803.
Upendra B, Meena D, Kandwal P, et al. Pedicle morphometry in patients with adolescent idiopathic scoliosis. Indian J Orthop 2010;44:169–76.
Kuraishi S, Takahashi J, Hirabayashi H, et al. Pedicle morphology using computed tomography-based navigation system in adolescent idiopathic scoliosis. J Spinal Disord Tech 2013;26:22–8.
Vrtovec T, Pernus F, Likar B. A review of methods for quantitative evaluation of axial vertebral rotation. Eur Spine J 2009;18:1079–90.
Author information
Authors and Affiliations
Corresponding author
Additional information
IRB approval
This study was reviewed and approved by the Medical Ethics Review Committee of the University Medical Center Utrecht.
Author disclosures
RCB (none); TPCS (none); DC (none); KLV (none); MvS (none); SCNH (none); WCWC (none); JCYC (none); RMC (grants from Alexandre Suerman UMC Utrecht PhD grant, grants from K2M research grant, grants from Medtronic research grant, outside the submitted work).
Rights and permissions
About this article
Cite this article
Brink, R.C., Schlösser, T.P.C., Colo, D. et al. Asymmetry of the Vertebral Body and Pedicles in the True Transverse Plane in Adolescent Idiopathic Scoliosis: A CT-Based Study. Spine Deform 5, 37–45 (2017). https://doi.org/10.1016/j.jspd.2016.08.006
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1016/j.jspd.2016.08.006