Impact of an intraoperative coronal spinal alignment measurement technique using a navigational tool for a 3D spinal rod bending system in adult spinal deformity cases

Masanari Takami MD, PhD1, Ryo Taiji MD1, Shunji Tsutsui MD, PhD1, Hiroshi Iwasaki MD, PhD1, Motohiro Okada MD, PhD1, Akihito Minamide MD, PhD1, Yasutsugu Yukawa MD, PhD1, Hiroshi Hashizume MD, PhD1, and Hiroshi Yamada MD, PhD1
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  • 1 Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
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OBJECTIVE

In corrective spinal surgery for adult spinal deformity (ASD), the focus has been on achieving optimal spinopelvic alignment. However, the correction of coronal spinal alignment is equally important. The conventional intraoperative measurement methods currently used for coronal alignment are not ideal. Here, the authors have developed a new intraoperative coronal alignment measurement technique using a navigational tool for a 3D spinal rod bending system (CAMNBS). The purpose of this study was to test the feasibility of using the CAMNBS for coronal spinal alignment and to evaluate its usefulness in corrective spinal surgery for ASD.

METHODS

In this retrospective cohort study, patients with degenerative lumbar kyphoscoliosis, a Cobb angle ≥ 20°, and lumbar lordosis ≤ 20° who had undergone corrective surgery (n = 67) were included. The pelvic teardrops on both sides, the S1 spinous process, the central point of the apex, a point on the 30-mm cranial (or caudal) side of the apex, and the central point of the upper instrumented vertebra (UIV) and C7 vertebra were registered using the CAMNBS. The positional information of all registered points was displayed as 2D figures on a monitor. Deviation of the UIV plumb line from the central sacral vertical line (UIV-CSVL) and deviation of the C7 plumb line from the CSVL (C7-CSVL) were measured using the 2D figures. Nineteen patients evaluated using the CAMNBS (BS group) were compared with 48 patients evaluated using conventional intraoperative radiography (XR group). The UIV-CSVL measured intraoperatively using the CAMNBS was compared with that measured using postoperative radiography. The prevalence of postoperative coronal malalignment (CM) and the absolute value of postoperative C7-CSVL were compared between the groups on radiographs obtained in the standing position within 4 weeks after surgery. Postoperative CM was defined as the absolute value of C7-CSVL ≥ 30 mm. Further, the measurement time and amount of radiation exposure were measured.

RESULTS

No significant differences in demographic, sagittal, and coronal parameters were observed between the two groups. UIV-CSVL was 2.3 ± 9.5 mm with the CAMNBS and 1.8 ± 16.6 mm with the radiographs, showing no significant difference between the two methods (p = 0.92). The prevalence of CM was 2/19 (10.5%) in the BS group and 18/48 (37.5%) in the XR group, and absolute values of C7-CSVL were 15.2 ± 13.1 mm in the BS group and 25.0 ± 18.0 mm in the XR group, showing statistically significant differences in both comparisons (p = 0.04 and 0.03, respectively). The CAMNBS method required 3.5 ± 0.9 minutes, while the conventional radiograph method required 13.3 ± 1.5 minutes; radiation exposure was 2.1 ± 1.1 mGy in the BS group and 2.9 ± 0.6 mGy in the XR group. Statistically significant differences were demonstrated in both comparisons (p = 0.0002 and 0.03, respectively).

CONCLUSIONS

From this study, it was evident that the CAMNBS did not increase postoperative CM compared with that seen using the conventional radiographic method, and hence can be used in clinical practice.

ABBREVIATIONS

ASD = adult spinal deformity; BMI = body mass index; CAMNBS = intraoperative coronal alignment measurement technique using a navigational tool for a 3D spinal rod bending system; CDA = coronal vertebra deformity angle; CM = coronal malalignment; CSR = coronal spine rigidity; CSVL = central sacral vertical line; LL = lumbar lordosis; LLIF = lateral lumbar interbody fusion; ODI = Oswestry Disability Index; PI = pelvic incidence; PT = pelvic tilt; SRS = Scoliosis Research Society; SRS-22r = refined 22-item SRS patient questionnaire; SS = sacral slope; SVA = sagittal vertical axis; UIV = upper instrumented vertebra; VAS = visual analog scale.

Illustrations from Hubbe et al. (pp 160–163). Copyright Ioannis Vasilikos and Roberto Ferrarese. Published with permission.

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