3D imaging, selective fusion may improve adolescent idiopathic scoliosis treatment
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Key takeaways:
- Three-dimensional imaging can provide a more accurate representation of deformity in the axial plane than 2D imaging.
- Selective fusion and shorter construct length may preserve motion segments.
Use of 3D imaging, selective fusion and limiting construct length may improve the treatment of adolescent idiopathic scoliosis, according to results.
“Between the sideways curvature, the flattening and the rotation, [adolescent idiopathic scoliosis] is a three-dimensional problem,” Suken A. Shah, MD, vice chair of the department of orthopedic surgery, division chief of the Spine and Scoliosis Center and clinical fellowship director at Nemours Children’s Health in Delaware, told Healio. “So, we should have a three-dimensional assessment. We should have a three-dimensional classification system.”
In a systematic review published in the Journal of the American Academy of Orthopaedic Surgeons, Shah and colleagues provided evidence for an improved 3D classification system in an attempt to improve surgical decision making and management of adolescent idiopathic scoliosis.
Shah said implementing 3D imaging, limiting construct length and selecting a fusion based on curve type can preserve motion segments, hasten recovery and provide a balanced correction.
Beyond the biomechanical improvements that patients with adolescent idiopathic scoliosis could have, Shah also stressed the importance of the improvements patients could have in their quality of life.
“We want to be able to assure them as much as we can that this is going to be a single event surgery that has a good track record of success, long term durability and standardized outcome,” Shah said. “Because, in the end, we want these kids to go back to being kids. We want them to return to sports, we want them to have limited time out of school and we want it to be an episode that they can put behind them and live the healthiest part of their lives later.”
“If we're able to provide selective curve treatment, if that preserves motion, it improves quality of life and probably decreases the need for additional surgery in the future,” he added.
Not only can 3D imaging help with treatment of severe spinal curves, but Shah said it may also be used to predict which milder curves may progress in the future.
“If we find there is a mild curvature that is not likely to progress, then why expose that patient to unnecessary radiation? Why expose that patient’s family to unnecessary anxiety when we don’t need to see them as often?” Shah said. “If we can take this 3D assessment and wind the clock back and look at mild curves, almost a pre-symptomatic identification of the condition, then customized treatment would be where we want to go in the future.”
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