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

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  • 1 Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon; and
  • 2 Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France

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.

Contributor Notes

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.

  • 1

    Acaroglu E, Yazici M, Deviren V, Alanay A, Cila A, Surat A: Does transverse apex coincide with coronal apex levels (regional or global) in adolescent idiopathic scoliosis? Stud Health Technol Inform 88:136139, 2002

    • Search Google Scholar
    • Export Citation
  • 2

    Al-Aubaidi Z, Lebel D, Oudjhane K, Zeller 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 22:409412, 2013

    • Search Google Scholar
    • Export Citation
  • 3

    Anitha H, Prabhu GK: Identification of apical vertebra for grading of idiopathic scoliosis using image processing. J Digit Imaging 25:155161, 2012

    • Search Google Scholar
    • Export Citation
  • 4

    Birchall D, Hughes DG, Hindle J, Robinson L, Williamson JB: Measurement of vertebral rotation in adolescent idiopathic scoliosis using three-dimensional magnetic resonance imaging. Spine (Phila Pa 1976) 22:24032407, 1997

    • Search Google Scholar
    • Export Citation
  • 5

    Drerup B: Principles of measurement of vertebral rotation from frontal projections of the pedicles. J Biomech 17:923935, 1984

  • 6

    Faro FD, Marks MC, Pawelek J, Newton PO: Evaluation of a functional position for lateral radiograph acquisition in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 29:22842289, 2004

    • Search Google Scholar
    • Export Citation
  • 7

    Hisam MA, Siti NS, Jou NP, Ghaneshinee S, Shaharuddin AR, Azmi B, : Does the quality of life in operated patients with adolescent idiopathic scoliosis correspond with the radiographic parameters? Malays Orthop J 9:3740, 2015

    • Search Google Scholar
    • Export Citation
  • 8

    Humbert L, De Guise JA, Aubert B, Godbout B, Skalli W: 3D reconstruction of the spine from biplanar x-rays using parametric models based on transversal and longitudinal inferences. Med Eng Phys 31:681687, 2009

    • Search Google Scholar
    • Export Citation
  • 9

    Humbert L, De Guise JA, Godbout B, Cresson T, Branchaud D, Chav 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 12:151152, 2009

    • Search Google Scholar
    • Export Citation
  • 10

    Ilharreborde B, Steffen JS, Nectoux E, Vital JM, Mazda K, Skalli W, : Angle measurement reproducibility using EOS three-dimensional reconstructions in adolescent idiopathic scoliosis treated by posterior instrumentation. Spine (Phila Pa 1976) 36:E1306E1313, 2011

    • Search Google Scholar
    • Export Citation
  • 11

    Illés T, Somoskeöy S: The EOS™ imaging system and its uses in daily orthopaedic practice. Int Orthop 36:13251331, 2012

  • 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 Standardization, 1994

    • Search Google Scholar
    • Export Citation
  • 13

    Kotwicki T: Evaluation of scoliosis today: examination, x-rays and beyond. Disabil Rehabil 30:742751, 2008

  • 14

    Lam GC, Hill DL, Le LH, Raso JV, Lou EH: Vertebral rotation measurement: a summary and comparison of common radiographic and CT methods. Scoliosis 3:16, 2008

    • Search Google Scholar
    • Export Citation
  • 15

    Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, : Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83:11691181, 2001

    • Search Google Scholar
    • Export Citation
  • 16

    Majdouline Y, Aubin CE, Robitaille M, Sarwark JF, Labelle H: Scoliosis correction objectives in adolescent idiopathic scoliosis. J Pediatr Orthop 27:775781, 2007

    • Search Google Scholar
    • Export Citation
  • 17

    McAlinden C, Khadka J, Pesudovs K: Precision (repeatability and reproducibility) studies and sample-size calculation. J Cataract Refract Surg 41:25982604, 2015

    • Search Google Scholar
    • Export Citation
  • 18

    Melhem E, Assi A, El Rachkidi R, Ghanem I: EOS® biplanar x-ray imaging: concept, developments, benefits, and limitations. J Child Orthop 10:114, 2016

    • Search Google Scholar
    • Export Citation
  • 19

    Merolli A, Leali P, Aulisa L, Guidi P, Impagnatello M: A new method for clinical measurement of vertebral rotation, in Sevastik JS, Diab KM (eds): Research Into Spinal Deformities 1. Studies in Health Technology and Informatics, Vol 37. Amsterdam: IOS Press, 1997, pp 147149

    • Search Google Scholar
    • Export Citation
  • 20

    Perdriolle R, Vidal J: Thoracic idiopathic scoliosis curve evolution and prognosis. Spine (Phila Pa 1976) 10:785791, 1985

  • 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) 19:236248, 1994

    • Search Google Scholar
    • Export Citation
  • 22

    Stokes IA, Bigalow LC, Moreland MS: Measurement of axial rotation of vertebrae in scoliosis. Spine (Phila Pa 1976) 11:213218, 1986

  • 23

    Sullivan TB, Reighard FG, Osborn EJ, Parvaresh KC, Newton PO: Thoracic idiopathic scoliosis severity is highly correlated with 3D measures of thoracic kyphosis. J Bone Joint Surg Am 99:e54, 2017

    • Search Google Scholar
    • Export Citation
  • 24

    Thomets J, Liu X, Lyon 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 Informatics, Vol 59. Amsterdam: IOS Press, 1999, pp 329331

    • Search Google Scholar
    • Export Citation
  • 25

    Weiss H: Technical error of vertebral rotation measurements, in D’Amico M, Merolli A, Santambrogio GC (eds): Three-Dimensional Analysis of Spinal Deformities. Studies in Health Technology and Informatics, Vol 15. Amsterdam: IOS Press, 1995, pp 243249

    • Search Google Scholar
    • Export Citation
  • 26

    Yazici M, Acaroglu ER, Alanay A, Deviren V, Cila A, Surat A: Measurement of vertebral rotation in standing versus supine position in adolescent idiopathic scoliosis. J Pediatr Orthop 21:252256, 2001

    • Search Google Scholar
    • Export Citation

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