Abstract
Study Design
Retrospective.
Objective
To develop and validate a prediction formula to estimate three-dimensional (3D) T5–T12 kyphosis in adolescent idiopathic scoliosis (AIS) from standard two-dimensional (2D) radiographic measurements.
Summary of Background Data
2D measurements of thoracic kyphosis in AIS patients overestimate 3D kyphosis; however, there is a lack of widespread availability of 3D imaging technology.
Methods
Retrospective review was performed for AIS patients with right thoracic curves evaluated with EOS Imaging from January 2010 to June 2014. Standard 2D posteroanterior and lateral radiographic measurements, pelvic incidence, Nash-Moe grade, Perdriolle rotation, and “3D T5–T12” sagittal measures (reconstructed with sterEOS, analyzed with custom MatLab code) were input into a multivariate logistic analysis to create a prediction model for 3D T5–T12 sagittal alignment. An initial cohort of 66 patients (curves 14°–85°) was used to create a predictive model, and a separate cohort of 129 patients (curves 16°–84°) was used to validate the formula.
Results
2D thoracic coronal Cobb and 2D T5–T12 kyphosis were the only significant predictors in the model. The prediction formula for estimating 3D T5–T12 sagittal measurement from standard 2D measurements, in degrees, was 18.1 + (0.81*2D T5–T12 sagittal Cobb) − (0.54*2D coronal Cobb), r2 = 0.84. The average model error between predicted and measured 3D T5–T12 kyphosis was ±7°. The predicted 3D T5–T12 kyphosis (8.6° ± 12.1°) and measured 3D T5–T12 kyphosis (8.5° ± 13.0°) were not significantly different (p = .8). 3D kyphosis was less than standard measures of 2D kyphosis (8.5° ± 13.0° vs. 20.2° ± 12.6°, p < .001).
Conclusion
This simple validated formula to predict 3D T5–T12 sagittal alignment using routine 2D thoracic Cobb and T5–T12 kyphosis for thoracic AIS patients has great potential value in assessing historical data collected prior to the development of 3D imaging methods as well as understanding/planning surgical hypokyphosis correction in patients without access to 3D imaging.
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KCP (none); EJO (none); FGR (reports grants from Setting Scoliosis Straight Foundation, during the conduct of the study); JD (reports grants from Setting Scoliosis Straight Foundation, during the conduct of the study); TPB (reports grants from Setting Scoliosis Straight Foundation, during the conduct of the study); PON (reports grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and other from Setting Scoliosis Straight Foundation, other from Rady Children’s Specialists, grants and personal fees from DePuy Synthes Spine, personal fees from Law firm of Carroll, Kelly, Trotter, Franzen & McKenna, personal fees from Law firm of Smith, Haughey, Rice & Roegge, grants from NIH, grants from OREF, grants and other from SRS, grants from EOS imaging, personal fees from Thieme Publishing, other from NuVasive, personal fees from Ethicon Endosurgery, other from Electrocore, personal fees from Cubist, other from International Orthopedic Think Tank, other from Orthopediatrics Institutional Support, personal fees from K2M, outside the submitted work; In addition, Dr. Newton has a patent Anchoring systems and methods for correcting spinal deformities (8540754) with royalties paid to DePuy Synthes Spine, a patent Low profile spinal tethering systems (8123749) issued to DePuy Spine, Inc., a patent Screw placement guide (7981117) issued to DePuy Spine, Inc., and a patent Compressor for use in minimally invasive surgery (7189244) issued to DePuy Spine, Inc.).
Study conducted Rady Children’s Hospital, San Diego.
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Parvaresh, K.C., Osborn, E.J., Reighard, F.G. et al. Predicting 3D Thoracic Kyphosis Using Traditional 2D Radiographic Measurements in Adolescent Idiopathic Scoliosis. Spine Deform 5, 159–165 (2017). https://doi.org/10.1016/j.jspd.2016.12.002
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DOI: https://doi.org/10.1016/j.jspd.2016.12.002