Search Results (3)

Background: The surgical treatment of adolescent idiopathic scoliosis (AIS) is influenced by factors such as skeletal maturity, curve magnitude, progression, and spinal flexibility. The assessment of spinal flexibility is crucial for surgical planning; supine bending radiographs are commonly used but there is no consensus on the optimal technique. Fulcrum bending radiographs (FBRs) have shown better prediction of post-surgery correction compared to supine bending radiographs. New radiological techniques allow a significant reduction in radiation exposure. This study aims to compare spinal flexibility assessment and radiation exposure between FBRs and standing side-bending radiographs (SSRs) using biplanar stereoradiography. Materials and Methods: Twenty-five consecutive AIS patients scheduled for surgery were included in this prospective cohort study. Exclusion criteria were non-idiopathic etiology, age younger than 12 years, and older than 18 years. Pre-surgery FBRs and SSRs were performed, and the Cobb angles were measured. Flexibility and correction rates were calculated. Dose–area products (DAPs) were recorded. Statistical analysis was conducted using the Wilcoxon signed-rank test and Spearman correlation. Results: The mean pre-surgery Cobb angle of the thoracic curve was 66.3°. The FBR was superior to SSR for assessing flexibility for thoracic curves and provided a better prediction for post-surgery correction. There was no significant difference in lumbar curves between FBR and SSR. The mean DAP for SSRs was 0.81 Gy*cm² compared to 3.42 Gy*cm² for FBR, indicating a lower radiation exposure using SSRs. Conclusions: FBRs are superior for flexibility assessment of thoracic curves in AIS and offers a better prediction of post-surgery correction compared to SSRs. However, FBR is associated with a higher radiation exposure. Full article

Background: Patients with scoliosis often require multiple imaging modalities. The aim of this study was to find out whether primary diagnosis, including surgical planning, could be carried out entirely without computed tomography (CT) scans and whether follow-up could be replaced with alternative methods without the use of X-rays. In order to reduce the radiation exposure in the diagnosis and treatment of severe scoliosis, we expect to replace X-rays with radiation-free or less-intensive radiation examinations. This study protocol is interdisciplinary. Methods: A total of 50 male and female patients (children and adolescents, aged 7–18 years) treated for scoliosis will be analyzed. In addition to routine projection radiographs, preoperative CT, and/or X-ray stereoradiography (EOS) examinations, thin-slice 3D magnetic resonance imaging (MRI) sequences will be retrospectively reformatted during the preoperative MRI examination. A three-dimensional back scan (video-raster stereography) and an intraoral scan will also be obtained. The following questions should be answered at the end of the project: (1) Can MRI examination with additional thin-slice 3D reconstruction answer all relevant questions for preoperative planning instead of CT? (2) Are EOS or whole-spine X-ray examinations in combination with MRI data sufficient for the evaluation of the pedicles and spinal deformity? (3) Does the Cobb angle in the radiograph correlate with the calculations from the back scanner image and can follow-up checks be replaced? (4) Are there any correlations between dental anomalies and scoliosis? Conclusions: Until now, pediatric patients with scoliosis have been diagnosed, monitored, and treated with numerous independent specialist disciplines, such as pediatricians, orthopedic surgeons, neurosurgeons, and general practitioners with different radiological issues. The aim of this project is to reduce radiation and lower perioperative risks by creating a preoperative and follow-up-related standard protocol in close interdisciplinary and targeted cooperation between all the specialist disciplines involved. In line with the holistic examination approach, the associated accompanying diseases and developmental disorders such as dental and neuronal malformations will also be examined. On the one hand, CT-based questions could be replaced with the reconstruction of thin-slice MRI sequences. In addition, it may be possible to use the three-dimensional back scan as an intermediate diagnostic procedure instead of X-rays in the monitoring of severe scoliosis. Insofar as correlations or causalities between scoliosis and occlusal anomalies, early orthodontic intervention could positively benefit the duration of therapy at a later stage. Full article

The three-dimensional nature of adolescent idiopathic scoliosis (AIS) necessitates a tridimensional assessment and management. Bracing constitutes the mainstay conservative treatment for mild adolescent idiopathic scoliosis. In the literature hitherto, there has been uncertainty regarding the behavior of the spine, pelvis, and vertebral orientations in the context of bracing, especially in the transverse plane. This poses a challenge to healthcare providers, patients, and their families, as brace treatment, although not as invasive as surgery, is laden with medical and psychological complications and could be considered traumatizing. Hence, a thorough understanding of initial three-dimensional spinal behavior in the context of bracing is important. The purpose of this retrospective study was to investigate the immediate 3D impact of Chêneau-type brace. Thirty-eight patients with AIS undergoing Chêneau-type bracing were included. Patients were stratified according to their structural curve topography into thoracic, thoracolumbar, and lumbar groups. 3D reconstruction of the spine using a dedicated biplanar stereoradiography software with and without the brace was performed. The examined anthropometric radiographic measures were pre- to in-brace variations and differences of spinopelvic parameters and vertebral orientations in the coronal, sagittal, and transverse planes. The complex impact of the Chêneau-type brace on different curves in three planes was delineated. In the coronal plane, the Cobb angle was significantly decreased in all types of curves, and the coronal tilt correction was concentrated in specific segments. The impact of the brace in this study on the sagittal profile was variable, including the loss of thoracic kyphosis and lumbar lordosis. In the transverse plane, an axial vertebral rotation change and detorsion above the apex occurred in the thoracolumbar curves. The results from this exploratory study could shed some light on the initial 3D spinal behavior in the context of bracing and may be of beneficial for treating physicians and brace makers. Full article