| ObjectiveTo assess the coronal balance during the surgery for adolescent idiopathic scoliosis(AIS)by cone-beam CT(CBCT)mosaic imaging combined with the measurement using an I-shaped measuring instrument,and to explore its application in the surgery for correcting AIS.MethodsClinical data of 48 AIS patients treated with posterior spinal fusion in the General Hospital of Northern Theater Command from January 2019 to January 2021 were retrospectively analyzed.AIS patients,with the mean age of 14.9±1.8(12～18)years were followed up for 1～2(1.8±0.2)years.They were classified based on the coronal balance as follows: Type A,coronal balance distance(CBD)<20 mm;Type B,CBD≥20mm and C7 plumb line(C7PL)shifted to the concave side of the main curve;Type C,CBD≥20 mm and C7 PL shifted to the convex side of the main curve.CBD ≥20 mm was defined as coronal balance.AIS patients were assessed for coronal balance by CBCT mosaic imaging combined with the measurement using an I-shaped measuring instrument.The main curve Cobb angle,CBD and pelvic coronal obliquity angle(PCOA)before the surgery,during the surgery,1 week after the surgery and the last follow-up visit were recorded.In addition,visual analogue scale(VAS)scores and Oswestry disability index(ODI)before the surgery and the last follow-up visit were recorded as well.Parameters reflecting the coronal balance and clinical orthopedic effect at each time point were compared.ResultsThe main curve Cobb angles of 48 AIS patients before the surgery,during the surgery,1 week after the surgery and the last follow-up visit were 58.45±12.81°,14.13±5.86°,14.48±5.98° and 14.39±5.74°,respectively,which,during the surgery and1 week after the surgery were significantly reduced compared with that before the surgery(both P<0.05).However,1 week after the surgery and last follow-up visit were significantly reduced compared with that during the surgery(both P>0.05),and no significant difference was detected between the main curve Cobb angle 1 week after the surgery and the last follow-up visit(P>0.05).The PCOAs before the surgery,during the surgery,1 week after the surgery and the last follow-up visit were 3.72±2.75°,1.25±0.97°,1.25±0.96° and 1.28±0.96°,respectively.A significant difference was detected in intraoperative PCOA and postoperative PCOA(P<0.05);While 1 week after the surgery and last follow-up visit were significantly reduced compared with that during the surgery(both P>0.05),and no significant difference was detected between the PCOA 1 week after the surgery and the last follow-up visit(P>0.05).The preoperative coronal imbalance rate of AIS patients was 47.91%(23/48),involving 15 cases with type B and 8 with type C.The CBDs of type A AIS patients before the surgery,during the surgery,1 week after the surgery and the last follow-up visit were12.53±4.46,8.06±3.15,8.37±3.13 and8.66±3.77,respectively.CBD during the surgery and 1 week after the surgery was significantly reduced compared with those before the surgery(P<0.05).However,1 week after the surgery and last follow-up visit were significantly reduced compared with that during the surgery(both P>0.05),and no significant difference in CBD 1 week after the surgery and the last follow-up(P>0.05).The CBDs of type B AIS patients before the surgery,during the surgery,1week after the surgery and the last follow-up visit were 24.57±4.60,14.91±4.62,14.95±4.49 and15.06±3.98,respectively,which in type C AIS patients were 26.46±6.78,16.58±4.00,16.94±4.12 and 16.58±3.97,respectively.CBDs during the surgery and 1week after the surgery in both type B and C AIS patients were significantly reduced compared with those before the surgery(all P<0.05).However,1 week after the surgery and last follow-up visit were significantly reduced compared with that during the surgery(both P>0.05),and no significant difference in CBD 1 week after the surgery and the last follow-up visit was detected in type B and C AIS patients(both P>0.05),coronal imbalance rate at the last follow-up was 10.42%(5 / 48).VAS scores(3.98±0.57 points vs.7.68±0.64 points)and ODI(21.82±3.12% vs.46.51±4.79%)at the last follow-up visit were significantly improved than preoperative ones(both P<0.05).ConclusionsThe CBCT mosaic imaging combined with the measurement using an I-shaped measuring instrument is an effective and powerful tool to intraoperatively assess the coronal balance,which assists spine surgeons to assess the coronal balance during the surgery for AIS.It timely adjusts the correction degree and effectively reduces the incidence of postoperative coronal imbalance. |
PDF Full Text Request