The deformity angular ratio: can three-dimensional computed tomography improve prediction of intraoperative neuromonitoring events?
Spine Deform
; 10(5): 1047-1053, 2022 09.
Article
in En
| MEDLINE
| ID: mdl-35648363
ABSTRACT
PURPOSE:
Assess whether a novel deformity angular ratio (DAR) calculated using preoperative three-dimensional computed tomography (3D CT) is more accurate than total DAR (T-DAR) radiographic measurements at predicting intraoperative neuromonitoring (IONM) events during vertebral column resection (VCR).METHODS:
Consecutive, unique patients undergoing thoracic VCR by a single surgeon from 2015 to 2021 were identified. The T-DAR was calculated by dividing the total radiographic Cobb angle by the number of vertebral segments the angle subtends. 3D CT DAR was calculated for each patient from a preoperative CT scan by finding the maximum angle subtended by three contiguous vertebral segments. All patients were assessed for IONM events. A binary threshold of 25 was used for T-DAR and 3D CT DAR measurements for predictive analysis. p < 0.05 indicated significance.RESULTS:
In total, 68 patients were identified. Mean age was 28 years. Mean levels fused was 15. Twenty-one patients (31%) had IONM events. In patients, with and without an IONM event, mean T-DAR was 26.6 ± 9.8 and 21.5 ± 8.8 (p = 0.04), respectively. 3D CT DAR mean values were 26.4 ± 10.8 and 18.4 ± 5.6, respectively (p < 0.001). 3D CT DAR accurately classified 81% of patients with a positive predictive value (PPV) of 75%. In comparison, T-DAR accurately classified 60% of patients with a PPV of 39%.CONCLUSION:
3D CT substantially improves preoperative IONM event prediction when compared to traditional radiographic measurements. A 3D CT DAR of 25 or greater was correlated with an increased rate of IONM events. 3D CT reconstructions are a useful adjunct for planning prior to a VCR.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Scoliosis
/
Kyphosis
Type of study:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Humans
Language:
En
Journal:
Spine Deform
Year:
2022
Type:
Article
Affiliation country:
United States