Coronal trunk imbalance in idiopathic scoliosis: Does gravity line localisation confirm the physical findings? - 29/06/18

Doi : 10.1016/j.otsr.2018.04.018

Thibault Hernandez ^a,^b,^⁎ , Thomas Thenard ^b, Claudio Vergari ^b, Leopold Robichon ^b, Wafa Skalli ^b, Raphaël Vialle ^a,^c
^a Service de chirurgie orthopédique et réparatrice de l’enfant, hôpital Armand-Trousseau, 26, avenue du Dr-Netter, 75012 Paris, France
^b Arts et metiers ParisTech, LBM/Institut de biomécanique humaine Georges-Charpak, 151, boulevard de l’Hôpital, 75013 Paris, France
^c Département hospitalo-universitaire, maladies musculo-squelettiques et innovations thérapeutiques, DHU-MAMUTH, hôpital Armand-Trousseau, 26, avenue du Dr-Netter, 75012 Paris, France

^⁎Corresponding author. Service de chirurgie orthopédique et réparatrice de l’enfant, hôpital Armand-Trousseau, 26, avenue du Dr-Netter, 75012 Paris, France.Service de chirurgie orthopédique et réparatrice de l’enfant, hôpital Armand-Trousseau26, avenue du Dr-NetterParis75012France

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Abstract

Background

Adolescent idiopathic scoliosis (AIS) can require surgical procedures that have major consequences. Coronal imbalance as assessed clinically using a plumb line is a key criterion for selecting patients to surgery. Nevertheless, the reference standard for assessing postural balance of the trunk is gravity line localisation within a validated frame of reference. Recent studies have established that the gravity line can be localised after body contour reconstruction from biplanar radiographs. The objective of this study was to validate a gravity line localisation method based on biplanar radiographs in a population with AIS then to validate gravity line position versus plumb line position.

Hypothesis

Plumb line and gravity line assessments of coronal balance correlate with each other.

Material and methods

A gravity line localisation method based on biplanar radiography was validated in 14 patients with AIS versus force platform as the method of reference. Normal plumb line and gravity line positions were determined in 27 asymptomatic adolescents using biplanar radiography. The results of the two methods were then compared in 53 patients with AIS.

Results

The reliability of gravity line localisation in the coronal plane based on biplanar radiography was 2.4mm (95% confidence interval). The distance between the gravity line and the middle of the line connecting the centres of the two femoral heads (HA) showed a strongly significant association with plumb line position computed as the distance from the vertical line through the middle of T1 and the centre of the S1 endplate (T1V/S): r=0.71, p<0.0001. Of the 20 patients with plumb line results indicating coronal imbalance, 11 (55%) had a normal gravity line-to-HA distance. Of the 33 patients with normal plumb line results, 7 (21%) had an abnormal gravity line-to-HA distance.

Conclusion

The results of this study validate gravity line determination from biplanar radiographs in a population with AIS. Plumb line position correlated significantly with gravity line position but was less accurate for guiding surgical decisions.