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The Reliability of Intraoperative Crossbar Technique in Determining the Upper Instrumented Vertebra (UIV) Tilt Angle for Adolescent Idiopathic Scoliosis (AIS) Undergoing Posterior Spinal Fusion

Kwan, Mun Keong MBBS, MSOrth*; Chiu, Chee Kidd MBBS, MSOrth*; Goh, Saw Huan MBBS*; Ng, Sherwin Johan MBBS*; Tan, Pheng Hian MBBS*; Chian, Xue Han MBBS*; Ng, Yun Hui MBBS*; Ler, Xin Yi MBBS*; Bashir, Elrofai Suliman MS Orth; Chan, Chris Yin Wei MD, MSOrth*

doi: 10.1097/BSD.0000000000000769
PRIMARY RESEARCH
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Study Design: Retrospective study.

Objective: This study looked into whether crossbar can reliably measure Upper Instrumend Vertebra (UIV) tilt angle intraoperatively and accurately predict the UIV tilt angle postoperatively and at final follow-up.

Summary of Background Data: Postoperative shoulder imbalance is a common cause of poor cosmetic appearance leading to patient dissatisfaction. There were no reports describing the technique or method in measuring the UIV tilt angle intraoperatively. Therefore, this study was designed to look into the reliability and accuracy of the usage of intraoperative crossbar in measuring the UIV tilt angle intraoperatively.

Methods: Lenke 1 and 2 Adolescent Idiopathic Scoliosis patients who underwent instrumented Posterior Spinal Fusion using pedicle screw constructs with minimum follow-up of 24 months were recruited for this study. After surgical correction, intraoperative UIV tilt angle was measured using a crossbar. Immediate postoperative and final follow up UIV tilt angle was measured on the standing anteroposterior radiographs.

Results: A total of 100 patients were included into this study. The reliability of the intraoperative crossbar to measure the optimal UIV tilt angle intraoperatively was determined by repeated measurements by assessors and measurement by different assessors. We found that the intra observer and inter observer reliability was very good with intraclass correlation coefficient values of >0.9. The accuracy of the intraoperative crossbar to measure the optimal UIV tilt angle intraoperatively was determined by comparing this measurement with the postoperative UIV tilt angle. We found that there was no significant difference (P>0.05) between intraoperative, immediate postoperative, and follow-up UIV tilt angle.

Conclusions: The crossbar can be used to measure the intraoperative UIV tilt angle consistently and was able to predict the postoperative UIV tilt angle. It was a cheap, simple, reliable, and accurate instrument to measure the intraoperative UIV tilt angle.

*Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

Elneelain University, Faculty of Medicine, Khartoum, Sudan

The authors declare no conflict of interest.

Reprints: Chee Kidd Chiu, MBBS, MSOrth, Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia (e-mail: cheekidd@um.edu.my).

Received July 9, 2018

Accepted November 26, 2018

© 2019 by Lippincott Williams & Wilkins, Inc.