Suk Se-Il, Kim Jin-Hyok, Cho Kyu-Jung, Kim Sung-Soo, Lee Jeong-Joon, Han Yong-Taek
Seoul Spine Institute, Inje University Sanggye Paik Hospital, 761-1 Sanggye Dong, Nowon-Ku, 139-707 Seoul, South Korea.
Eur Spine J. 2007 Sep;16(9):1359-65. doi: 10.1007/s00586-007-0334-x. Epub 2007 Mar 3.
With the advent of segmental pedicle screw fixation that enables more powerful corrective forces, it is postulated that an additional anterior procedure may be unnecessary even in severe deformities. The purpose of this paper is to evaluate the results of a posterior procedure alone using segmental pedicle screw fixation in severe scoliotic curves over 70 degrees . Thirty-five scoliosis patients treated by pedicle screw fixation and rod derotation were retrospectively analyzed after a minimum follow-up of 2 years (range 2-10.4). The mean age of patients was 15.3 years (range 9.8-34.2). Diagnoses were idiopathic scoliosis in 29, neuromuscular scoliosis in 3 and scoliosis associated with Marfan syndrome in 3. Scoliosis consisted of single thoracic curve in 18, double thoracic in 5 and double major in 12. Twenty-five patients showed a major thoracic curve greater than 70 degrees (range 70-100), and different ten patients showed a major lumbar curve greater than 70 degrees (range 70-105), pre-operatively. The deformity angle, lowest instrumented vertebral tilt (LIVT) and spinal balance were measured. Pre-operatively there were nine patients with coronal decompensation. The pre-operative thoracic curve of 80 +/- 9 degrees with the flexibility of 45 +/- 11% (45 +/- 11 degrees in side-bending film) was corrected to 27 +/- 10 degrees at the most recent follow-up, showing a correction of 66% (53 degrees) and loss of correction of 3.0% (3.7 degrees). The pre-operative lumbar curve of 79 +/- 12 degrees with the flexibility of 62 +/- 14% (30 +/- 11 degrees in side-bending film) was corrected to 33 +/- 14 degrees at the most recent follow-up [59% (46 degrees) curve correction, 3.5% (3.0 degrees) loss of curve correction]. The pre-operative LIVT of 30 +/- 8 degrees was corrected to 11 +/- 6 degrees, showing a correction of 62% (19 degrees). Residual coronal decompensation was observed in three patients postoperatively. Pre-operative thoracic kyphosis of 27 degrees (range 0-82) improved postoperatively to 31 degrees (range 14-53). In conclusion, posterior segmental pedicle screw fixation without anterior release in severe scoliosis had satisfactory deformity correction without significant loss of curve correction. In this series a posterior procedure alone obviated the need for the anterior release and avoided complications related anterior surgery.
随着节段性椎弓根螺钉固定技术的出现，其能够施加更强大的矫正力，因此有人推测，即使在严重畸形的情况下，额外的前路手术可能也没有必要。本文的目的是评估仅采用节段性椎弓根螺钉固定的后路手术治疗70度以上严重脊柱侧弯的效果。对35例接受椎弓根螺钉固定和棒旋转矫正的脊柱侧弯患者进行回顾性分析，随访时间最短为2年（范围2 - 10.4年）。患者的平均年龄为15.3岁（范围9.8 - 34.2岁）。诊断为特发性脊柱侧弯29例，神经肌肉型脊柱侧弯3例，与马凡综合征相关的脊柱侧弯3例。脊柱侧弯包括单胸弯18例，双胸弯5例，双主弯12例。术前，25例患者的主胸弯大于70度（范围为度70 - 100），另外10例患者的主腰弯大于70度（范围为70 - 105）。测量了畸形角度、最低固定椎体倾斜度（LIVT）和脊柱平衡情况。术前有9例患者存在冠状面失代偿。术前胸弯为80±9度，柔韧性为45±11%（侧弯位片为45±11度），在最近一次随访时矫正至27±10度，矫正率为66%（53度），矫正丢失率为3.0%（3.7度）。术前腰弯为79±12度，柔韧性为62±14%（侧弯位片为30±11度），在最近一次随访时矫正至33±14度[矫正率为59%（46度），矫正丢失率为3.5%（3.0度）]。术前LIVT为30±8度，矫正至11±6度，矫正率为62%（19度）。术后有3例患者观察到残留冠状面失代偿。术前胸段后凸为27度（范围0 - 82度），术后改善至31度（范围14 - 53度）。总之，严重脊柱侧弯患者采用后路节段性椎弓根螺钉固定且不进行前路松解，畸形矫正效果满意，矫正丢失不明显。在本系列研究中，仅采用后路手术避免了前路松解的必要性，并避免了与前路手术相关的并发症。
