Burton Douglas C, Asher Marc A, Lai Sue Min
Section of Orthopedic Surgery and the Department of Preventative Medicine, University of Kansas Medical Center, Kansas City 66160-7387, USA.
Spine (Phila Pa 1976). 2002 Nov 1;27(21):2363-7. doi: 10.1097/00007632-200211010-00010.
Since the advent of single, stiff rod anterior instrumentation, and now dual rod anterior instrumentation, most thoracolumbar-lumbar scoliosis is treated with an anterior approach. We have previously reported a retrospective comparison of patients with single torsion thoracolumbar-lumbar scoliosis treated with either anterior or posterior instrumented fusion. The purpose of this study is to examine the patient-based outcomes in this cohort of patients at an average of 5 years (anterior instrumentation) and 9 years (posterior instrumentation).
Inclusion criteria were as follows: 1) single torsion thoracolumbar or lumbar curve of <or=70 degrees; 2) thoracic curve bends to <or=20 degrees on nonstressed supine bends; and 3) thoracic kyphosis of <or=60 degrees. Fourteen patients were treated with posterior transpedicular instrumented fusion from 1989 to 1993 (none treated with anterior discectomy). Fourteen patients were treated with anterior, single, solid rod instrumented fusion from 1993 to 1996. SRS 22 was performed after surgery in 12 of 14 patients from the posterior group (average 9.2 years) and in 14 of 14 patients from the anterior group (average 5.1 years).
Posterior: The average age was 14.8 years (range 12-17.8 years). Curve correction at average 6.5 years (range 4.0-10.9 years) was 75%. The average lower instrumented vertebra was L3.1. There were no complications. Twelve of 14 patients completed SRS 22 at an average of 9.2 years (range 6.2-10.9 years). Domain scores for Pain, Self-Image, Function, Mental Health, Satisfaction, and Total were 3.8, 4.1, 4.0, 3.8, 4.5, and 4.1, respectively. Anterior: The mean age was 14.5 years (range 12.5-16.5 years). Curve correction at average 4.8 years (range 2.3-7.6 years) was 63% (instrumented segment 89%). The average lower instrumented vertebra was L2.6. Complications included one intercostal neuritis that resolved with suture removal, one broken inferior screw that healed with some loss of correction, and one pseudarthrosis treated successfully with posterior fusion. Fourteen of 14 patients completed SRS 22 at an average of 5.3 years (range 2.0-7.6 years). Domain scores for Pain, Self-Image, Function, Mental Health, Satisfaction, and Total were 4.1, 4.3, 4.4, 4.0, 4.5, and 4.3, respectively. There were no statistically significant differences in any of the domains or the Total score, although there was a trend toward improved function in the patients treated anteriorly. The follow-up was statistically longer in the posterior group.
At an average of 9 years of follow-up, patients treated with posterior transpedicular instrumentation have equivalent patient-based outcomes to patients treated with anterior single solid rod instrumentation at an average of 5 years of follow-up.
自从单根刚性棒前路器械固定技术出现，以及现在的双棒前路器械固定技术出现以来，大多数胸腰段-腰段脊柱侧弯采用前路手术治疗。我们之前曾报道过对采用前路或后路器械融合术治疗的单扭转胸腰段-腰段脊柱侧弯患者进行的回顾性比较。本研究的目的是在平均5年（前路器械固定）和9年（后路器械固定）时，检查该队列患者基于患者的治疗结果。
纳入标准如下：1）单扭转胸腰段或腰段侧弯，角度≤70度；2）在非负重仰卧位侧弯时，胸段侧弯角度≤20度；3）胸段后凸角度≤60度。1989年至1993年，14例患者接受了后路经椎弓根器械融合术（均未行前路椎间盘切除术）。1993年至1996年，14例患者接受了前路单根实心棒器械融合术。后路组14例患者中的12例（平均9.2年）和前路组14例患者中的14例（平均5.1年）术后进行了SRS 22评估。
后路：平均年龄14.8岁（范围12 - 17.8岁）。平均6.5年（范围4.0 - 10.9年）时的侧弯矫正率为75%。平均下固定椎为L3.1。无并发症。14例患者中的12例平均在9.2年（范围6.2 - 10.9年）完成了SRS 22评估。疼痛、自我形象、功能、心理健康、满意度和总分的领域得分分别为3.8、4.1、4.0、3.8、4.5和4.1。前路：平均年龄14.5岁（范围12.5 - 16.5岁）。平均4.8年（范围2.3 - 7.6年）时的侧弯矫正率为63%（固定节段89%）。平均下固定椎为L2.6。并发症包括1例肋间神经炎，拆除缝线后缓解；1例下螺钉断裂，愈合后有一定程度的矫正丢失；1例假关节，经后路融合成功治疗。14例患者中的14例平均在5.3年（范围2.0 - 7.6年）完成了SRS 22评估。疼痛、自我形象、功能、心理健康、满意度和总分的领域得分分别为4.1、4.3、4.4、4.0、4.5和4.3。尽管前路治疗的患者功能有改善趋势，但在任何领域或总分方面均无统计学显著差异。后路组的随访在统计学上更长。
平均随访9年时，接受后路经椎弓根器械固定的患者与平均随访5年时接受前路单根实心棒器械固定的患者基于患者的治疗结果相当。
