Radiological Assessment of Pediatric Scoliosis Patients
Date
2021
Authors
Suomalainen, Saara Anni Susanna
Journal Title
Journal ISSN
Volume Title
Publisher
Latvijas Universitāte
Abstract
Nosaukums: Radioloģiskais izmeklējums pediatriskiem pacientiem ar skoliozi Autore: Saara Anni Susanna Suomalainen, medicīnas studente Darba vadītājs: Dr. med. Paulis Laizāns un Dr. med. Jānis Upenieks Priekšvēsture : Skolioze ir sānu novirze, kas pārsniedz 10 grādus no normāla mugurkaula, mērot pēc rentgenogrammas, un tāpēc, ka sānu līkne ir saistīta ar skriemeļu rotāciju līknes iekšienē, rodas trīsdimensiju deformācija. Idiopātiskā skolioze bērnu populācijā ir sadalīta trīs vecuma grupās - zīdaiņu, bērnu un pusaudžu. Radiogrāfiskais novērtējums ir galīgās diagnozes pīlārs. Labi uzņemtos rentgenogrammās var novērtēt segmentācijas anomāliju raksturojumu, izliekumu veidu un to elastību, kā arī slimības progresēšanu un ārstēšanas uzraudzību. Mērķi: Attēldiagnostikas radioloģiskais un kvalitatīvais izvērtējums pirms- un pēcoperācijas periodā operētiem idiopātiskās skoliozes pacientiem, kā arī salīdzināt bērnu un pusaudžu atšķirības. Mērķis bija tos salīdzināt ar iepriekš publicētajiem datiem un atrast rezultātu, kas ietekmētu turpmākos ārstēšanas ieteikumus. Materiāli un metodes: 52 idiopātiskas skoliozes pacientu radioloģiskās attēldiagnostikas retrospektīva analīze, kas 2016.-2020. Gadā tika hospitalizēti operatīvai ārstēšanai Latvijas Bērnu slimnīcā, ieskaitot. Respondenti sastāvēja no septiņiem nepilngadīgajiem un 45 pusaudžiem. Radioloģiskie attēli tika analizēti datamed.lv PACS sistēmā un ar leņķa lineālu tiem, kuriem pirms un pēc operācijas nebija rentgena. Primārā datu analīze tika veikta Microsoft Office Excel un statistiskā analīze IBM SPSS programmatūrā. Rezultāti: Pirms un pēc operācijas attēldiagnostikas kvalitātei bija būtiski trūkumi. Gandrīz pusei gadījumu bija lieliska pēcoperācijas attēlveidošana, kad tikai 25% gadījumu pirmsoperācijas attēlveidošana bija lieliska. Pirmsoperācijas MR tika veikts piecos no septiņiem gadījumiem bērnu grupā (71,4%) un 28 reizes no 45 gadījumiem pusaudžu grupā (62,2%). Skriemeļu rotācija bija augstāka krūšu kurvja rajonā pusaudžiem nekā pusaudžiem (p = 0,002), bet jostas rotācijā nebija statistiskas nozīmes. Vidējais pirmsoperācijas Koba leņķis 1 bija plašāks bērniem, 59,14 grādi, nekā pusaudžiem 47,49 grādi ar statistisku nozīmīgumu (p = 0,008). Pusaudžiem fiksēto līmeņu vidējais rādītājs bija nedaudz mazāks, taču statistikas atšķirības starp vecuma grupām nebija (p = 0,674). Vidējā galvenās līknes korekcija grādos bija bērnu grupā 33,71 un pusaudžiem 25,72, taču statistikas nozīmības salīdzinājumā ar grupām nebija (p = 0,068). Secinājums: Galvenās līknes pirmsoperācijas pakāpe bija izteiktāka bērniem nekā pusaudžiem. Galvenās līknes vidējā korekcija grupās neatšķīrās, un hospitalizācijas ilgums bija līdzīgs. Skeleta vecums operācijas laikā pusaudžiem bija daudz augstāks nekā pusaudžiem. Jāuzlabo pirmsoperācijas un pēcoperācijas attēldiagnostikas kvalitāte, papildinot to ar Lenke klasifikāciju. Pirms operācijas MRI jāveic visiem agrīnā sākuma skoliozes pacientiem.
Title: Radiological Assessment of Pediatric Scoliosis Patients. Author: S. Suomalainen, med.stud. Supervisor: MD Laizans & MD Upenieks. Background: Scoliosis is a lateral deviation >10 degrees of the normal spine measured on a radiograph and because the lateral curve is associated with rotation of the vertebrae within the curve, a 3D deformity occurs. Idiopathic scoliosis in pediatric population is divided to three age groups - infantile, juvenile and adolescent. The radiographic evaluation is the pillar for definitive diagnosis. In well-taken radiographs, the characterization of the segmentation abnormalities, the type of the curvatures and their flexibility can be assessed as well as disease progression and treatment monitoring. Objectives: Radiological assessment of pre- and postoperative imaging results of the operative treatment of the idiopathic pediatric scoliosis and the quality of the imaging. Comparison of juveniles and adolescents differences and comparison to previously published data and find a result, that would have an impact on further treatment recommendations. Materials & methods: Retrospective analysis of radiological imaging of 52 idiopathic scoliosis patients hospitalized for operative treatment in Children’s Hospital of Latvia during 2016-2020 including. Population consisted of 7 juveniles and 45 adolescents. The radiological images were analyzed in datamed.lv PACS and with angle ruler in those, who didn’t have the pre- and postoperative X-rays in the system. The primary data-analysis was done in MSO Excel and statistical analysis in IBM SPSS. Results: The quality of pre- and postoperative imaging had major shortcomings. Almost half of the cases had excellent post-operative imaging, when preoperative imaging was excellent in only 25% of cases. Preoperative MRI was taken in 5 out of 7 cases in the juveniles (71.4%) and 28 times out of 45 of cases in the adolescents (62.2%). The vertebral rotation was higher grade in thoracic region in juveniles than in adolescents (p=0.002), but there was no statistical significance in lumbar rotation. The mean preoperative Cobb angle 1 was more extensive in juveniles, 59.14 degrees, than in adolescents 47.49 degrees (p=0.008). The Risser grade was higher in operated juveniles than in adolescents (p=0.04). The adolescents had slightly smaller mean of fixed levels, but there was no statistical difference between the age groups (p=0.674). The mean correction of the major curve in degrees was in juveniles 33.71 and in adolescents 25.72, but there was no statistical significance in comparison of the groups (p=0.068). Conclusions: The preoperative degree of major curve was more pronounced in juveniles than adolescents. The mean correction of the major curve didn't differ in the groups and the duration of hospitalization was similar. The quality of pre- and postoperative imaging should improve by adding Lenke classification. Preoperative MRI should be taken in juvenile patients.
Title: Radiological Assessment of Pediatric Scoliosis Patients. Author: S. Suomalainen, med.stud. Supervisor: MD Laizans & MD Upenieks. Background: Scoliosis is a lateral deviation >10 degrees of the normal spine measured on a radiograph and because the lateral curve is associated with rotation of the vertebrae within the curve, a 3D deformity occurs. Idiopathic scoliosis in pediatric population is divided to three age groups - infantile, juvenile and adolescent. The radiographic evaluation is the pillar for definitive diagnosis. In well-taken radiographs, the characterization of the segmentation abnormalities, the type of the curvatures and their flexibility can be assessed as well as disease progression and treatment monitoring. Objectives: Radiological assessment of pre- and postoperative imaging results of the operative treatment of the idiopathic pediatric scoliosis and the quality of the imaging. Comparison of juveniles and adolescents differences and comparison to previously published data and find a result, that would have an impact on further treatment recommendations. Materials & methods: Retrospective analysis of radiological imaging of 52 idiopathic scoliosis patients hospitalized for operative treatment in Children’s Hospital of Latvia during 2016-2020 including. Population consisted of 7 juveniles and 45 adolescents. The radiological images were analyzed in datamed.lv PACS and with angle ruler in those, who didn’t have the pre- and postoperative X-rays in the system. The primary data-analysis was done in MSO Excel and statistical analysis in IBM SPSS. Results: The quality of pre- and postoperative imaging had major shortcomings. Almost half of the cases had excellent post-operative imaging, when preoperative imaging was excellent in only 25% of cases. Preoperative MRI was taken in 5 out of 7 cases in the juveniles (71.4%) and 28 times out of 45 of cases in the adolescents (62.2%). The vertebral rotation was higher grade in thoracic region in juveniles than in adolescents (p=0.002), but there was no statistical significance in lumbar rotation. The mean preoperative Cobb angle 1 was more extensive in juveniles, 59.14 degrees, than in adolescents 47.49 degrees (p=0.008). The Risser grade was higher in operated juveniles than in adolescents (p=0.04). The adolescents had slightly smaller mean of fixed levels, but there was no statistical difference between the age groups (p=0.674). The mean correction of the major curve in degrees was in juveniles 33.71 and in adolescents 25.72, but there was no statistical significance in comparison of the groups (p=0.068). Conclusions: The preoperative degree of major curve was more pronounced in juveniles than adolescents. The mean correction of the major curve didn't differ in the groups and the duration of hospitalization was similar. The quality of pre- and postoperative imaging should improve by adding Lenke classification. Preoperative MRI should be taken in juvenile patients.
Description
Keywords
Medicīna , Juvenile idiopathic scoliosis , , adolescent idiopathic scoliosis , Lenke classification , Cobb angle , pre- and postoperative imaging