Purpose: Scoliosis is a three-dimensional deformation of the spinal column. Modern surgical techniques have attempted to address this 3D component of the problem but pre- and postoperative measurements lack precision. A solution is stereoradiographic 3D reconstruction providing 1.1 mm precision for vertebral shape and 1.4° precision for axial rotation.
Material and methods: Ten patients (seven adolescents and three adults) with idiopathic scoliosis (mean 56°, range 36°–78°) were treated with an in situ arching method. A calibrated teleradiogram (AP and lateral view) was obtained before and after surgery. The spinal columns were reconstructed by stereoradiography. Six rotation angles were measured in the three planes for each vertebra and each intervertebral space, taking into account the curvatures and their apical and junctional zones.
Results: Preoperatively, for thoracic scoliosis, measurements were: mean vertebral axial rotation (VAR) measured at the apex = 20°; mean lateral axial rotation (LAR) of the junctional zones = 30°; mean intervertebral rotation (IVR) = 10°. Depending on the curvatures, in situ arching yielded a 52–60% correction of the VAR at the apex, and 78–79% correction of the junctional zones. VLR of the junctional zoenes was improved 58–74%. Intervertebral sagittal rotation (ISR) at the summit (kyphosis) was improved 5.5° on the average.
Discussion: Unlike computed tomoraphy where scans are obtained in the supine position, three-dimensional reconstruction of the spinal column enables a precise analysis of the loaded spine. Improvement was significant in the frontal plane with 18.3° and 21.4° improvement of the VLR for the thoracic and thoracolumbar junctional zones respectively, compared with the rod rotation where the peroperative stereophotogram showed a 9.6° and 8.6° gain respectively. There was a real improvement in VAR, differing from the literature where the rotation of the rod appears to be less pronounced.
Conclusion: Three-dimensional reconstruction of the spinal column enables a segmentary analysis of scoliosis deformations. In addition, by enabling a view of the spinal column in all directions, angle measurements can be made with precision allowing repeated measurements and comparisons. This technique demonstrated the efficacy of in situ arching in improving vertebral rotation.
