Deviren Vedat, Berven Sigurd, Kleinstueck Frank, Antinnes James, Smith Jason A, Hu Serena S
Department of Orthopaedic Surgery, University of California San Francisco, 94143, USA.
Spine (Phila Pa 1976). 2002 Nov 1;27(21):2346-9. doi: 10.1097/00007632-200211010-00007.
A retrospective evaluation of radiographs in patients with idiopathic scoliosis was undertaken to assess predictors of flexibility.
To evaluate potential predictors of flexibility in patients with thoracolumbar and lumbar scoliosis.
Curve flexibility is an important consideration in the operative management of idiopathic scoliosis. Flexibility of the major curve is a useful predictor of expected surgical correction, and flexibility of compensatory curves determines whether they are structural or nonstructural. An accurate assessment of curve flexibility has important implications on surgical approaches and planning for deformity correction. The role of age and curve magnitude in predicting curve flexibility has not been well defined. A quantitative assessment of changes in curve flexibility with age and progression of deformity may yield important insight into the change in surgical management options over time.
A retrospective review of 75 patients with idiopathic thoracolumbar and lumbar scoliosis (age range 13-78 years) was undertaken. Preoperative standing and side-bending radiographs of thoracolumbar and lumbar curves were evaluated. Cobb angles of structural and fractional curves, curve flexibility, presence of lateral listhesis, and axial and radicular pain were documented. Predictors of structural and fractional curve flexibility were evaluated with correlation and regression analysis. Correlation analysis was used to demonstrate an association between radiographic findings and the clinical presentation.
Seventy-five patients had an average major curve magnitude of 56 degrees (range 34-82 degrees ) with flexibility averaging 55% (range 20-93%). Structural curve flexibility was highly inversely correlated with both curve magnitude (r = -0.7; P< 0.001) and with age (r = -0.6; P< 0.001). Lumbar fractional curve (L4-S1) flexibility showed a high inverse correlation with age (r = -0.65; P< 0.001) but did not show correlation with Cobb angle. Thoracic compensatory curves showed a moderate correlation with Cobb angle (r = 0.53). Structural and fractional curve flexibility showed high correlation with each other (r = 0.5-0.66). Regression analysis yielded a formula to predict the flexibility of the structural curve (FSC): FSC = 130 - (Cobb + Age/2). Axial pain was correlated with age (r = 0.63); however, it was not correlated with curve magnitude.
We have shown that curve magnitude and patient age are the main predictors of structural flexibility. Every 10 degrees increase in curve magnitude over 40 degrees results in a 10% decrease in flexibility; every 10-year increase in age decreases flexibility of the structural curve by 5% and the lumbosacral fractional curve by 10%. Curve magnitude and age of the patients are significant predictors of curve flexibility. The demonstration of this association offers useful information in estimating how surgical options for deformity correction may change over time.
对特发性脊柱侧凸患者的X线片进行回顾性评估，以评估柔韧性的预测因素。
评估胸腰段和腰段脊柱侧凸患者柔韧性的潜在预测因素。
在特发性脊柱侧凸的手术治疗中，曲线柔韧性是一个重要的考虑因素。主曲线的柔韧性是预期手术矫正效果的一个有用预测指标，而代偿曲线的柔韧性则决定了它们是结构性还是非结构性的。准确评估曲线柔韧性对手术方法和畸形矫正计划具有重要意义。年龄和曲线大小在预测曲线柔韧性方面的作用尚未明确界定。对曲线柔韧性随年龄和畸形进展变化的定量评估可能会为手术治疗方案随时间的变化提供重要见解。
对75例特发性胸腰段和腰段脊柱侧凸患者（年龄范围13 - 78岁）进行回顾性研究。评估胸腰段和腰段曲线的术前站立位和侧弯位X线片。记录结构性和分数曲线的Cobb角、曲线柔韧性、侧方滑脱的存在情况以及轴向和神经根性疼痛。通过相关性和回归分析评估结构性和分数曲线柔韧性的预测因素。相关性分析用于证明影像学表现与临床表现之间的关联。
75例患者的平均主曲线大小为56度（范围34 - 82度），柔韧性平均为55%（范围20 - 93%）。结构性曲线柔韧性与曲线大小（r = -0.7；P < 0.001）和年龄（r = -0.6；P < 0.001）均呈高度负相关。腰段分数曲线（L4 - S1）柔韧性与年龄呈高度负相关（r = -0.65；P < 0.001），但与Cobb角无相关性。胸段代偿曲线与Cobb角呈中度相关（r = 0.53）。结构性和分数曲线柔韧性彼此之间呈高度相关（r = 0.5 - 0.66）。回归分析得出一个预测结构性曲线柔韧性（FSC）的公式：FSC = 130 - （Cobb + 年龄/2）。轴向疼痛与年龄相关（r = 0.63）；然而，它与曲线大小无关。
我们已经表明，曲线大小和患者年龄是结构性柔韧性的主要预测因素。曲线大小超过40度每增加10度，柔韧性就会降低10%；年龄每增加10岁，结构性曲线的柔韧性降低5%，腰骶段分数曲线的柔韧性降低10%。患者的曲线大小和年龄是曲线柔韧性的重要预测因素。这种关联的证明为估计畸形矫正手术方案随时间的变化提供了有用信息。
