Evaluation of the three-dimensional deformities in scoliosis surgery with computed tomography: Efficacy and relationship with clinical outcomes

Study Design. Prospective radiological and clinical study with scoliosis patients. Objective. To determine the pre- and postoperative differences in the three-dimensional (3D) parameters and relationships with the outcome in scoliosis surgery. Summary of Background Data. Despite a proven important role of the 3D deformities in scoliosis, it is warranted to confirm the efficacy of these measurements, which carry a cost burden and radiation hazard. Methods. Fifty adolescent idiopathic scoliosis patients who underwent correction surgery were enrolled in this study. Pre- and postoperative whole spine radiographs and computed tomography were performed. The vertebral rotation (VR), rib hump index (RH), sternal shift (SS) on computed tomography were measured at the level of the apex in each patient. In addition, the patients described the SRS 30 (scoliosis research society 30) and ODI (owestry disability index) score. And, the differences in the parameter and the relationships between the radiological and clinical outcomes were analyzed. Results. There was significant decrease in the coronal curvature, RH, and SS after surgery (P < 0.0001). In addition, the VR decreased postoperatively but that was not significant (P = 0.236). There were significant relationships between the parameters in the coronal curvature, VR, RH, and SS, pre- and postoperatively (P < 0.05). However, regarding the pre- and postoperative differences, only the changes in the SS were related to changes in the coronal curvature (P = 0.006). In addition, there were significant relationships between the parameters and outcomes. The changes in ODI were related to changes in the coronal curvature, VR, RH, and SS (P < 0.0001, P = 0.039, P < 0.0001, P = 0.019, respectively). However, the changes in the SRS was only related to the changes in SS (P < 0.0001). Conclusion. There were significant correlations between the VR, RH, and SS with the coronal curvature, pre- and postoperatively. In addition, there were significant correlations between the 3D deformities and outcomes. Computed tomography based measurements of 3D deformities can provide useful information in planning, and predicting the outcome of corrective surgery.