SpringerLink
Log in

Is the morphology of the apical pedicles influenced by apical rotation or the coronal curve magnitude in adolescent idiopathic scoliosis?: a radiographic assessment

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Introduction

Asymmetry in pedicle anatomy is most distinctly noted around the apex of the curve. The correlation of pedicle dysmorphia with apical vertebral rotation (AVR) and coronal Cobb angle (CCA) has not been studied.

Objective

To establish whether pedicle dysmorphism is linked to curve magnitude CCA and the AVR in adolescent idiopathic scoliosis (AIS).

Methodology

Preoperative plain whole spine standing radiographs and non-contrast computed tomography (CT) scans of 25 AIS patients that were operated at a single centre from 2013 to 2019 were retrospectively reviewed by 3 independent co-investigators. CCA was noted on the standing radiograph, whereas the AVR was measured on the axial cuts of CT scan. Pedicle morphometric measurements were performed for apical and periapical pedicles. These included apical vertebra (when present), 2 vertebrae above (U1 and U2) and below (B1 and B2) the apex vertebra/disc. The pedicle morphometric measurements were performed on CT scans. We assessed the transverse pedicle diameter, transverse cancellous channel diameter, sagittal pedicle diameter, pedicle length and pedicle axis length. Correlation tests between various pedicle morphometric measurements, AVR and the curve magnitude (Cobb angle) was performed by the Pearson correlation test.

Results

The apex of the major curve was in the thoracic spine in 20 patients, thoracolumbar in three patients and in the lumbar spine in two patients. The mean Cobb angle was 61.5 ± 9.3° and the mean AVR was 28.4 ± 17.8°. A positive correlation was noted with the AVR for U1 concave pedicle length (r = 0.45, p = 0.03), pedicle axis length of the U2 concave pedicle (r = 0.6, p = 0.04), transverse pedicle diameter of the convex apical vertebrae (r = 0.82, p = 0.00009) and the convex apical transverse pedicle diameter (r = 0.80, p = 0.002). A negative correlation with the AVR was noted for U2 convex pedicle length (r = − 0.51, p = 0009), transverse cancellous channel diameter of the U2 concave pedicle (r = − 0.42, p = 0.04) and apical concave pedicle (r = − 0.78, p = 0.002) and the sagittal pedicle diameter for the convex pedicle of U2 (r = − 0.45, p = 0.03) and apex(r = − 0.59, p = 0.04). The Cobb angle did not show a significant correlation with any of the pedicle measurements at any of the levels on the convex and the concave sides.

Conclusion

Pedicle asymmetry and dysmorphism demonstrate a morphometric association with the apical vertebral rotation than the curve magnitude. The pedicle length and the pedicle axis length increase on the concave apical and periapical region with increase in AVR. The transverse cancellous channel diameter significantly decreases on the concave apical region with the increase in AVR. The sagittal pedicle diameter decreases on the convex side with the increase in AVR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (France)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

Available.

Code availability

Not applicable.

References

  1. Weiss HR, Karavidas N, Moramarco M, Moramarco K (2016) Long-term effects of untreated adolescent idiopathic scoliosis: a review of the literature. Asian Spine J 10(6):1163–1169. https://doi.org/10.4184/asj.2016.10.6.1163

    Article  PubMed  PubMed Central  Google Scholar 

  2. Chen Z, Rong L (2016) Comparison of combined anterior–posterior approach versus posterior-only approach in treating adolescent idiopathic scoliosis: a meta-analysis. Eur Spine J 25(2):363–371. https://doi.org/10.1007/s00586-015-3968-0

    Article  CAS  PubMed  Google Scholar 

  3. Shufflebarger HL, Geck MJ, Clark CE (2004) The posterior approach for lumbar and thoracolumbar adolescent idiopathic scoliosis: posterior shortening and pedicle screws. Spine 29(3):269–276. https://doi.org/10.1097/01.BRS.0000109881.63411.48

    Article  PubMed  Google Scholar 

  4. Gao B, Gao W, Chen C et al (2017) What is the difference in morphologic features of the thoracic pedicle between patients with adolescent idiopathic scoliosis and healthy subjects? A CT-based case-control study. Clin Orthop 475(11):2765–2774. https://doi.org/10.1007/s11999-017-5448-9

    Article  PubMed  PubMed Central  Google Scholar 

  5. Liljenqvist UR, Allkemper T, Hackenberg L, Link TM, Steinbeck J, Halm HFH (2002) Analysis of vertebral morphology in idiopathic scoliosis with use of magnetic resonance imaging and multiplanar reconstruction. J Bone Jt Surg Am 84(3):359–368. https://doi.org/10.2106/00004623-200203000-00005

    Article  Google Scholar 

  6. Aaro S, Dahlborn M, Svensson L (1978) Estimation of vertebral rotation in structural scoliosis by computer tomography. Acta Radiol Diagn (Stockh) 19(6):990–992. https://doi.org/10.1177/028418517801900614

    Article  CAS  PubMed  Google Scholar 

  7. Vaccaro AR, Rizzolo SJ, Allardyce TJ et al (1995) Placement of pedicle screws in the thoracic spine. Part I: morphometric analysis of the thoracic vertebrae. J Bone Jt Surg Am 77(8):1193–1199. https://doi.org/10.2106/00004623-199508000-00008

    Article  CAS  Google Scholar 

  8. Akazawa T, Kotani T, Sakuma T, Minami S, Tsukamoto S, Ishige M (2015) Evaluation of pedicle screw placement by pedicle channel grade in adolescent idiopathic scoliosis: should we challenge narrow pedicles? J Orthop Sci Off J Jpn Orthop Assoc 20(5):818–822. https://doi.org/10.1007/s00776-015-0746-0

    Article  Google Scholar 

  9. Akoglu H (2018) User’s guide to correlation coefficients. Turk J Emerg Med 18(3):91–93. https://doi.org/10.1016/j.tjem.2018.08.001

    Article  PubMed  PubMed Central  Google Scholar 

  10. Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15(2):155–163. https://doi.org/10.1016/j.jcm.2016.02.012

    Article  PubMed  PubMed Central  Google Scholar 

  11. Davis CM, Grant CA, Pearcy MJ et al (2017) Is there asymmetry between the concave and convex pedicles in adolescent idiopathic scoliosis? A CT investigation. Clin Orthop 475(3):884–893. https://doi.org/10.1007/s11999-016-5188-2

    Article  PubMed  Google Scholar 

  12. Sarwahi V, Sugarman EP, Wollowick AL, Amaral TD, Lo Y, Thornhill B (2014) Prevalence, distribution, and surgical relevance of abnormal pedicles in spines with adolescent idiopathic scoliosis vs. no deformity: a CT-based study. JBJS 96(11):e92. https://doi.org/10.2106/JBJS.M.01058

    Article  Google Scholar 

  13. Davis CM, Grant CA, Izatt MT et al (2020) Characterization of progressive changes in pedicle morphometry and neurovascular anatomy during growth in adolescent idiopathic scoliosis versus adolescents without scoliosis. Spine Deform 8(6):1193–1204. https://doi.org/10.1007/s43390-020-00160-y

    Article  PubMed  Google Scholar 

  14. Vavruch L, Forsberg D, Dahlström N, Tropp H (2018) Vertebral axial asymmetry in adolescent idiopathic scoliosis. Spine Deform 6(2):112-120.e1. https://doi.org/10.1016/j.jspd.2017.09.001

    Article  PubMed  Google Scholar 

  15. Tarrant RC, Queally JM, O’Loughlin PF, Sheeran P, Moore DP, Kiely PJ (2016) Preoperative curves of greater magnitude (>70°) in adolescent idiopathic scoliosis are associated with increased surgical complexity, higher cost of surgical treatment and a delayed return to function. Ir J Med Sci 1971 185(2):463–471. https://doi.org/10.1007/s11845-015-1391-5

    Article  CAS  Google Scholar 

  16. Labaki C, Otayek J, Massaad A et al (2019) Is the apical vertebra the most rotated vertebra in the scoliotic curve? J Neurosurg Spine 31(6):873–879. https://doi.org/10.3171/2019.6.SPINE19203

    Article  Google Scholar 

  17. Watanabe K, Lenke LG, Matsumoto M et al (2010) A novel pedicle channel classification describing osseous anatomy: how many thoracic scoliotic pedicles have cancellous channels? Spine 35(20):1836–1842. https://doi.org/10.1097/BRS.0b013e3181d3cfde

    Article  PubMed  Google Scholar 

Download references

Funding

There is no funding source for this publication/study.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India

    Bhavuk Garg & Nishank Mehta

  2. Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

    Tungish Bansal

  3. Royal Orthopaedic Hospital, Birmingham, UK

    Jwalant Mehta

Authors
  1. Bhavuk Garg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tungish Bansal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nishank Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jwalant Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Concept and design: BG, TB, NM, JM. Data acquisition: BG, TB, JM. Data analysis: BG, TB, NM. Manuscript preparation: TB, JM. Manuscript editing: BG, TB, NM, JM. Approval of final version of manuscript: BG, TB, NM, JM.

Corresponding author

Correspondence to Tungish Bansal.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

Approval was obtained from the ethics committee of All India Institute of Medical Sciences, New Delhi. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

Patients signed informed consent regarding publishing their data and photographs.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Garg, B., Bansal, T., Mehta, N. et al. Is the morphology of the apical pedicles influenced by apical rotation or the coronal curve magnitude in adolescent idiopathic scoliosis?: a radiographic assessment. Spine Deform 12, 341–348 (2024). https://doi.org/10.1007/s43390-023-00773-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43390-023-00773-z

Keywords

Search

Navigation