Is the apical vertebra the most rotated vertebra in the scoliotic curve?

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OBJECTIVE

The aim of this study was to determine if the apical vertebra (AV) in patients with adolescent idiopathic scoliosis (AIS) is the most rotated vertebra in the scoliotic segment.

METHODS

A total of 158 patients with AIS (Cobb angle range 20°–101°) underwent biplanar radiography with 3D reconstructions of the spine and calculation of vertebral axial rotations. The type of major curvature was recorded (thoracic, thoracolumbar, or lumbar), and both major and minor curvatures were included. The difference of levels (DL) between the level of maximal vertebral rotation (LMVR) and the AV was calculated as follows: DL = 0 if LMVR and AV were the same, DL = 1 if LMVR was directly above or below the AV, and DL = 2 if LMVR was separated by 1 vertebra or more from the AV. To investigate which factors explained the divergence of the LMVR from the AV, multinomial models were computed.

RESULTS

The distribution of the DL was as follows: for major curvatures, 143 were DL = 0, 11 were DL = 1, and 4 were DL = 2; and for minor curvatures, 53 were DL = 0, 9 were DL = 1, and 31 were DL = 2. The determinants of a DL = 2 (compared with DL = 0) were lumbar curvature (compared with thoracic; adjusted OR 0.094, p = 0.001), major curvature (compared with minor; adjusted OR 0.116, p = 0.001), and curvatures with increasing apical vertebral rotation (adjusted OR 0.788, p < 0.001).

CONCLUSIONS

This study showed that the AV is the most rotated vertebra in the majority of major curvatures, while in minor curvatures, the most rotated vertebra appears to be the junctional vertebra between major and minor curvatures in a significant proportion of cases.

ABBREVIATIONS AIS = adolescent idiopathic scoliosis; aOR = adjusted odds ratio; AV = apical vertebra; AVR = apical vertebral rotation; DL = difference of levels; LL = lumbar lordosis; LMVR = level of maximal vertebral rotation; TK = thoracic kyphosis.

Article Information

Correspondence Ayman Assi: University of Saint-Joseph, Beirut, Lebanon. ayman.assi@gmail.com, ayman.assi@usj.edu.lb.

INCLUDE WHEN CITING Published online August 23, 2019; DOI: 10.3171/2019.6.SPINE19203.

Disclosures Dr. Skalli: coinventor of the EOS low-dose x-ray system.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Full-body low-dose biplanar radiographs (A) with 3D reconstruction of the spine (frontal [B], lateral [C], and horizontal [D] views). Figure is available in color online only.

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    Frontal and sagittal spinopelvic parameters obtained from 3D reconstructions. PI = pelvic incidence; PT = pelvic tilt; SS = sacral slope. Figure is available in color online only.

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    DL between the LMVR (red vertebrae) and the AV (yellow vertebrae). A: DL = 0. B: DL = 1. C: DL = 2. The blue vertebrae are upper and lower limits of the curvature. Figure is available in color online only.

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    Distribution of the DL in major and minor curvatures. Figure is available in color online only.

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    Average values (degrees) of the spinopelvic parameters along with their standard deviations (error bars) in 158 patients with AIS. Figure is available in color online only.

References

  • 1

    Acaroglu EYazici MDeviren VAlanay ACila ASurat A: Does transverse apex coincide with coronal apex levels (regional or global) in adolescent idiopathic scoliosis? Stud Health Technol Inform 88:1361392002

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Al-Aubaidi ZLebel DOudjhane KZeller R: Three-dimensional imaging of the spine using the EOS system: is it reliable? A comparative study using computed tomography imaging. J Pediatr Orthop B 22:4094122013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Anitha HPrabhu GK: Identification of apical vertebra for grading of idiopathic scoliosis using image processing. J Digit Imaging 25:1551612012

  • 4

    Birchall DHughes DGHindle JRobinson LWilliamson JB: Measurement of vertebral rotation in adolescent idiopathic scoliosis using three-dimensional magnetic resonance imaging. Spine (Phila Pa 1976) 22:240324071997

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Drerup B: Principles of measurement of vertebral rotation from frontal projections of the pedicles. J Biomech 17:9239351984

  • 6

    Faro FDMarks MCPawelek JNewton PO: Evaluation of a functional position for lateral radiograph acquisition in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 29:228422892004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Hisam MASiti NSJou NPGhaneshinee SShaharuddin ARAzmi B: Does the quality of life in operated patients with adolescent idiopathic scoliosis correspond with the radiographic parameters? Malays Orthop J 9:37402015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Humbert LDe Guise JAAubert BGodbout BSkalli W: 3D reconstruction of the spine from biplanar x-rays using parametric models based on transversal and longitudinal inferences. Med Eng Phys 31:6816872009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Humbert LDe Guise JAGodbout BCresson TBranchaud DChav R: Fast 3D reconstruction of the spine from biplanar radiography: a diagnosis tool for routine scoliosis diagnosis and research in biomechanics. Comput Methods Biomech Biomed Engin 12:1511522009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Ilharreborde BSteffen JSNectoux EVital JMMazda KSkalli W: Angle measurement reproducibility using EOS three-dimensional reconstructions in adolescent idiopathic scoliosis treated by posterior instrumentation. Spine (Phila Pa 1976) 36:E1306E13132011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Illés TSomoskeöy S: The EOS™ imaging system and its uses in daily orthopaedic practice. Int Orthop 36:132513312012

  • 12

    International Organization for Standardization: ISO 5725-2: Accuracy (Trueness and Precision) of Measurement Methods and Results—Part 2: Basic Method for the Determination of Repeatability and Reproducibility of a Standard Measurement Method. Geneva: International Organization for Standardization1994

    • Search Google Scholar
    • Export Citation
  • 13

    Kotwicki T: Evaluation of scoliosis today: examination, x-rays and beyond. Disabil Rehabil 30:7427512008

  • 14

    Lam GCHill DLLe LHRaso JVLou EH: Vertebral rotation measurement: a summary and comparison of common radiographic and CT methods. Scoliosis 3:162008

  • 15

    Lenke LGBetz RRHarms JBridwell KHClements DHLowe TG: Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83:116911812001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Majdouline YAubin CERobitaille MSarwark JFLabelle H: Scoliosis correction objectives in adolescent idiopathic scoliosis. J Pediatr Orthop 27:7757812007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    McAlinden CKhadka JPesudovs K: Precision (repeatability and reproducibility) studies and sample-size calculation. J Cataract Refract Surg 41:259826042015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Melhem EAssi AEl Rachkidi RGhanem I: EOS® biplanar x-ray imaging: concept, developments, benefits, and limitations. J Child Orthop 10:1142016

  • 19

    Merolli ALeali PAulisa LGuidi PImpagnatello M: A new method for clinical measurement of vertebral rotation in Sevastik JSDiab KM (eds): Research Into Spinal Deformities 1. Studies in Health Technology and InformaticsVol 37. Amsterdam: IOS Press1997 pp 147149

    • Search Google Scholar
    • Export Citation
  • 20

    Perdriolle RVidal J: Thoracic idiopathic scoliosis curve evolution and prognosis. Spine (Phila Pa 1976) 10:7857911985

  • 21

    Stokes IA: Three-dimensional terminology of spinal deformity: a report presented to the Scoliosis Research Society by the Scoliosis Research Society Working Group on 3-D Terminology of Spinal Deformity. Spine (Phila Pa 1976) 19:2362481994

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Stokes IABigalow LCMoreland MS: Measurement of axial rotation of vertebrae in scoliosis. Spine (Phila Pa 1976) 11:2132181986

  • 23

    Sullivan TBReighard FGOsborn EJParvaresh KCNewton PO: Thoracic idiopathic scoliosis severity is highly correlated with 3D measures of thoracic kyphosis. J Bone Joint Surg Am 99:e542017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Thomets JLiu XLyon R: Axial rotation in idiopathic scoliosis: a comparison of the Perdriolle, Scoliometer, Quantec Spinal Image System in Stokes IAF (eds): Research Into Spinal Deformities 2. Studies in Health Technology and InformaticsVol 59. Amsterdam: IOS Press1999 pp 329331

    • Search Google Scholar
    • Export Citation
  • 25

    Weiss H: Technical error of vertebral rotation measurements in D’Amico MMerolli ASantambrogio GC (eds): Three-Dimensional Analysis of Spinal Deformities. Studies in Health Technology and InformaticsVol 15. Amsterdam: IOS Press1995 pp 243249

    • Search Google Scholar
    • Export Citation
  • 26

    Yazici MAcaroglu ERAlanay ADeviren VCila ASurat A: Measurement of vertebral rotation in standing versus supine position in adolescent idiopathic scoliosis. J Pediatr Orthop 21:2522562001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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