[Perioperative radiographic reconstruction of the scoliotic vertebral column]

We have developed a new per-operative three dimensional (3D) reconstruction technique to evaluate the 3D correction of a scoliotic spine induced by surgery using Cotrel-Dubousset instrumentation. A small object with 15 embedded markers was used to calibrate the radiographic system. During surgery, the calibration object was sterilized and fixed to the patient just before the acquisition of two pairs of posterior-anterior and sagittal radiographs; one pair before the rotation maneuver of the rod and one pair after the maneuver. The markers were digitized on each radiograph and their relative 3D positions were measured to establish the relation between the 3D positions of the anatomical structures and their 2D positions on the radiographs. This relation was used to calculate the 3D position of six anatomical landmarks per vertebra (the centers of the superior and inferior vertebral body endplates and the proximal and distal bodies of both pedicles) from the identification of these landmarks on each radiograph. We made a 3D representation of the thoracic and lumbar spine of three patients with idiopathic scoliosis undergoing corrective surgery by the posterior approach. Clinical indices (Cobb angle, axial rotation and the plane of maximum curvature) computed from the 3D reconstruction of the spine obtained before and after the rotation maneuver of the rod were compared to evaluate the 3D correction performed during the surgery. The new proposed approach allows the surgeon to evaluate the per-operative shape of the spine. This approach is simpler, faster and less risky for the patient than the previous method which employed an electromagnetic digitizer to measure the 3D coordinates of anatomical landmarks located on the posterior part of the spine. Furthermore, the 3D representation of the spine visualized from different points of view gives the surgeon an accurate evaluation of the 3D correction during the surgical procedure.