Aorta Movement in Patients With Scoliosis After Posterior Surgery.
STUDY DESIGN.: Retrospective analysis. OBJECTIVE.: To evaluate movement of the aorta in patients with scoliosis who have undergone the posterior correction and fusion. SUMMARY OF BACKGROUND DATA.: Surgeons check preoperative imaging for pedicle screw placement, but past analyses indicated that the aorta shifts after scoliosis surgery. Few studies, however, evaluated the aorta movement in detail. METHODS.: A total of 22 patients with a right thoracic curve underwent posterior instrumentation and fusion. The average age at surgery was 17.2 years. The average of the preoperative Cobb angle was 65.2 degrees which decreased to 20.0 degrees .Computed-tomographic data were analyzed by multiplanar reconstruction. In our coordinate system, the middle of the base of the left superior facet was set as the origin and a line connecting the middle points of both bases of the superior facets was defined as the X-axis. We defined the angle and the distance to describe the aorta position and analyzed the movement of the aorta relative to the spine. Deformity parameters were examined to determine their correlation with the aorta parameters.We simulated variable pedicle screw placement and defined a warning pedicle when the aorta enters the expected area of the screw and examined them in 24 scenarios. RESULTS.: The aorta moved 4.7 +/- 3.0 mm on an average. The aorta had a tendency to migrate in the anteromedial direction and this movement correlated with preoperative apical vertebral translation, preoperative sagittal alignment, and change of sagittal alignment. The ratio of warning pedicles at the middle thoracic level (T7-T9) increased after deformity correction. CONCLUSION.: The aorta moved anteromedially relative to the spine after the posterior correction and the risk of the aorta by a pedicle screw increased by correction of the deformity at the middle thoracic spine. Surgeons are recommended to anticipate the aorta movement in the surgical planning.
From the *Department of Orthopaedic Surgery, the University of Tokyo, Tokyo, Japan; and the daggerDepartment of Orthopaedic Surgery, the Saitama Medical Center, Saitama, Japan.
This article was published in the following journal.
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20714278
- DOI: http://dx.doi.org/10.1097/BRS.0b013e3181cf0cb6
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Medical and Biotech [MESH] Definitions
The portion of the descending aorta proceeding from the arch of the aorta and extending to the DIAPHRAGM, eventually connecting to the ABDOMINAL AORTA.
Surgery which could be postponed or not done at all without danger to the patient. Elective surgery includes procedures to correct non-life-threatening medical problems as well as to alleviate conditions causing psychological stress or other potential risk to patients, e.g., cosmetic or contraceptive surgery.
Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery.
Complications that affect patients during surgery. They may or may not be associated with the disease for which the surgery is done, or within the same surgical procedure.
A condition of persistent pain and discomfort in the BACK and the LEG following lumbar surgery, often seen in patients enrolled in pain centers.