[Three-Dimensional Surgical Correction of Scoliotic Curves Monitored Using the EOS Imaging].

PURPOSE OF THE STUDY: Structural scoliosis is a three-dimensional deformity that adversely affects the frontal, sagittal, and axial planes. Surgical correction of scoliotic deformities in children requires effective correction of all three planes, with restoration of a balanced position of the spine and the entire trunk. Using modern surgical instruments and targeted intraoperative maneuvers, we achieve this comprehensive 3D correction. The EOS Imaging System enables effective preoperative planning and postoperative verification of outcomes based on software processing of the acquired X-ray images. The aim of the study was to objectively assess the achieved surgical outcomes under the hypothetical assumption of effective surgical correction of spinal deformity in all three planes.

MATERIAL AND METHODS: In the study, 20 patients with a primary diagnosis of adolescent idiopathic scoliosis were examined. All patients underwent a posterior spinal fusion within the planned extent of instrumentation. Stabilisation was achieved exclusively through transpedicular screw fixation, by applying derotation, rod reduction and translation correction maneuvers. The cohort was divided symmetrically into two groups: patients with primary thoracic structural curves who underwent selective correction in this region, and patients with primary double thoracolumbar structural curves who underwent surgery on both curves. All patients underwent preoperative evaluation using the EOS Imaging System, with subsequent follow-up examinations within a week after surgery and at 4, 12, and 24 months postoperatively.

RESULTS: In both groups, a statistically significant correction of all three curves in the frontal plane and a statistically significant apical vertebral derotation were observed for both the main thoracic and lumbar curves. When comparing the two groups, statistically significant differences were found only in the preoperative lumbar Cobb angle (45.0° for selective instrumentation vs. 53.8° for instrumentation of both curves, p < 0.05) and in its absolute change during the surgical procedure (29.9° vs. 42.1°, p < 0.05). No statistically significant difference was found between the groups in the percentage of lumbar curve correction in the frontal plane (p = 0.147), in the derotation of lumbar apical vertebra (p = 0.147), or in the other evaluated parameters. No statistically significant differences were found in the sagittal parameters, either when comparing preoperative and postoperative conditions within individual groups (p > 0.05) or when comparing the two groups with each other (p > 0.05). Thus, no significant change occurred in the sagittal profile, and sagittal balance was maintained after surgery regardless of the chosen extent of instrumentation.

DISCUSSION: In both groups, a statistically significant correction of all three curves in the frontal plane and a statistically significant apical vertebral derotation were observed for both the main thoracic and lumbar curves. Significant three-dimensional correction can only be achieved using transpedicular fixation. In his biomechanical study, Le Neveaux confirmed that a higher screw density, particularly on the concave side, promotes more effective correction in the frontal and axial planes. We consider the finding of high-quality correction of secondary, non-operated curves alongside effective correction of the primary, operated thoracic curve to be a significant result.

CONCLUSIONS: Modern surgical instruments, combined with effective corrective maneuvers, enable efficient three-dimensional correction of the operated segments of the spine as well as parallel correction of unoperated secondary curves. Radiological examination using an EOS device offers precise verification of the surgical outcome with minimal radiation exposure. Three-dimensional correction of spinal deformities is currently the clear method of choice, and every specialized center should utilize modern instrumentation and its various capabilities for effective correction in all planes of the spine.