Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Spine Journal
Published in: European Spine Journal 12/2021

Open Access 01-12-2021 | Scoliosis | Original Article

Assessment of pedicle size in patients with scoliosis using EOS 2D imaging: a validity and reliability study

Authors: C. M. M. Peeters, L. van Houten, D. H. R. Kempen, F. H. Wapstra, P. C. Jutte, I. van den Akker-Scheek, C. Faber

Published in: European Spine Journal | Issue 12/2021

Login to get access

Abstract

Purpose

Free-hand pedicle screw insertion methods are widely used for screw insertion during scoliosis surgery. Preoperative knowledge about the pedicle size helps to maximize screw containment and minimize the risk of pedicle breach. Radiographs taken by a biplanar low-dose X-ray device (EOS) have no divergence in the vertical plane. The criterion validity and reliability of preoperative EOS images for pedicle size measurements in patients with idiopathic scoliosis (IS) was investigated in this study.

Methods

Sixteen patients who underwent surgical treatment for IS were prospectively included. Intra- and extracortical pedicle height and width measurements on EOS images were compared with reconstructed intra-operative 3D images of the isthmus of included pedicles. Secondly, intra- and interobserver reliability of pedicle size measurements on EOS images was determined.

Results

The total number of analyzed pedicles was 203. The correlation between the EOS and 3D scan measurements was very strong for the intra- and extracortical pedicle height and strong for the intra- and extracortical pedicle width. There are, however, significant, but likely clinically irrelevant differences (mean absolute differences < 0.43 mm) between the two measure methods for all four measurements except for extracortical pedicle height. For pedicles classified as Nash–Moe 0, no significant differences in intra- and extracortical pedicle width were observed. Both intra- and interobserver reliability was excellent for all pedicle size measurements on EOS images.

Conclusion

The results of this study indicate a good validity and reliability for pedicle size measurements on EOS radiographs. Therefore, EOS radiographs may be used for a preoperative estimation of pedicle size and subsequent screw diameter in patients with IS.
Appendix
Available only for authorised users
Literature
1.
McCormick J, Aebi M, Toby D et al (2013) Pedicle screw instrumentation and spinal deformities: have we gone too far? Eur Spine J 22(Suppl 2):S216–S224CrossRef
2.
Kotani T, Akazawa T, Sakuma T et al (2014) Accuracy of pedicle screw placement in scoliosis surgery: a comparison between conventional computed tomography-based and O-arm-based navigation techniques. Asian Spine J 8:331–338CrossRef
3.
Maruyama T, Takeshita K (2008) Surgical treatment of scoliosis: a review of techniques currently applied. Scoliosis 3:6CrossRef
4.
Stepanovich MMG, Yaszay B (2015) Complications of the treatment of adolescent idiopathic scoliosis. Semin Spine Surg 27:58–61CrossRef
5.
Brink RC, Schlosser TPC, Colo D et al (2017) Asymmetry of the vertebral body and pedicles in the true transverse plane in adolescent idiopathic scoliosis: a CT-based study. Spine Deform 5:37–45CrossRef
6.
Chan A, Parent E, Narvacan K et al (2017) Intraoperative image guidance compared with free-hand methods in adolescent idiopathic scoliosis posterior spinal surgery: a systematic review on screw-related complications and breach rates. Spine J 17:1215–1229CrossRef
7.
Solitro GF, Whitlock K, Amirouche F et al (2019) Currently adopted criteria for pedicle screw diameter selection. Int J Spine Surg 13:132–145CrossRef
8.
Belmont PJ Jr, Klemme WR, Dhawan A et al (2001) In vivo accuracy of thoracic pedicle screws. Spine 26:2340–2346CrossRef
9.
Somoskeoy S, Tunyogi-Csapo M, Bogyo C et al (2012) Accuracy and reliability of coronal and sagittal spinal curvature data based on patient-specific three-dimensional models created by the EOS 2D/3D imaging system. Spine J 12:1052–1059CrossRef
10.
Vidal C, Ilharreborde B, Azoulay R et al (2013) Reliability of cervical lordosis and global sagittal spinal balance measurements in adolescent idiopathic scoliosis. Eur Spine J 22:1362–1367CrossRef
11.
Lam GC, Hill DL, Le LH et al (2008) Vertebral rotation measurement: a summary and comparison of common radiographic and CT methods. Scoliosis 3:16CrossRef
12.
Meijer MF, Boerboom AL, Bulstra SK et al (2017) Do CAS measurements correlate with EOS 3D alignment measurements in primary TKA? Knee Surg Sports Traumatol Arthrosc 25:2894–2903CrossRef
13.
Domholdt E (2000) Physical therapy research: principles and applications. 2nd edn. WB Saunders Co., Philadelophia
14.
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310CrossRef
15.
Rankin G, Stokes M (1998) Reliability of assessment tools in rehabilitation: an illustration of appropriate statistical analyses. Clin Rehabil 12:187–199CrossRef
16.
Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155–163CrossRef
17.
Lee DH, Lee SW, Kang SJ et al (2011) Optimal entry points and trajectories for cervical pedicle screw placement into subaxial cervical vertebrae. Eur Spine J 20:905–911CrossRef
18.
Lien SB, Liou NH, Wu SS (2007) Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine. Eur Spine J 16:1215–1222CrossRef
19.
Di Silvestre M, Parisini P, Lolli F et al (2007) Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976) 32:1655–61CrossRef
20.
Takeshita K, Maruyama T, Chikuda H et al (2009) Diameter, length, and direction of pedicle screws for scoliotic spine: analysis by multiplanar reconstruction of computed tomography. Spine (Phila Pa 1976) 34:798–803CrossRef
21.
Christodoulou AG, Apostolou T, Ploumis A et al (2005) Pedicle dimensions of the thoracic and lumbar vertebrae in the Greek population. Clin Anat 18:404–408CrossRef
22.
Suk SI, Kim WJ, Lee SM et al (2001) Thoracic pedicle screw fixation in spinal deformities: are they really safe? Spine (Phila Pa 1976) 26:2049–57CrossRef
23.
Verlaan JJ, van de Kraats EB, van Walsum T et al (2005) Three-dimensional rotational X-ray imaging for spine surgery: a quantitative validation study comparing reconstructed images with corresponding anatomical sections. Spine (Phila Pa 1976) 30:556–61CrossRef
24.
Kuraishi S, Takahashi J, Hirabayashi H et al (2013) Pedicle morphology using computed tomography-based navigation system in adolescent idiopathic scoliosis. J Spinal Disord Tech 26:22–28CrossRef
Metadata
Title
Assessment of pedicle size in patients with scoliosis using EOS 2D imaging: a validity and reliability study
Authors
C. M. M. Peeters
L. van Houten
D. H. R. Kempen
F. H. Wapstra
P. C. Jutte
I. van den Akker-Scheek
C. Faber
Publication date
01-12-2021
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 12/2021
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-021-06839-8

Other articles of this Issue 12/2021

European Spine Journal 12/2021 Go to the issue

Review Article

Comparison of interventions and outcomes of enhanced recovery after surgery: a systematic review and meta-analysis of 2456 adolescent idiopathic scoliosis cases

Review Article

Advanced meta-analyses comparing the three surgical techniques total disc replacement, anterior stand-alone fusion and circumferential fusion regarding pain, function and complications up to 3 years to treat lumbar degenerative disc disease

Original Article

Patient-rated outcome after atlantoaxial (C1-C2) fusion: more than a decade of evaluation of 2-year outcomes in 126 patients

Author's reply

Answer to the letter to the editor of L. Zhao et al. concerning “The correlation of intraoperative distraction of intervertebral disc with the postoperative canal and foramen expansion following oblique lumbar interbody fusion” by Lin G-X, et al. (Eur Spine J. 2021; 30(1):151–163)

Announcements

Announcements

Original Article

Surgical increase in thoracic kyphosis predicts increase of cervical lordosis after thoracic fusion for adolescent idiopathic scoliosis