Langerak Nelleke G, Vaughan Christopher L, Hoffman Edward B, Figaji Anthony A, Fieggen A Graham, Peter Jonathan C
MRC/UCT Medical Imaging Research Unit, Department of Human Biology, University of Cape Town, Observatory, Cape Town, Western Cape 7925, South Africa.
Childs Nerv Syst. 2009 Dec;25(12):1593-1603. doi: 10.1007/s00381-009-0993-5.
The aim of this study was to evaluate the mechanical status of the spine in patients with spastic diplegia 17-26 years after selective dorsal rhizotomy (SDR).
We compared original radiographic reports from our earlier short-term follow-up study with current X-rays. In addition, we obtained magnetic resonance images (MRI) of the spine and additional information regarding back pain and clinical assessments.
Thirty patients (17 males and 13 females; median age 26.8 years) participated in the current study, with median follow-up times of 4.0 and 21.4 years. Comparison of the X-ray results showed respectively: scoliosis 0% and 57%; kyphosis 0% and 7%; lordosis 21% and 40%; spondylolysis 18% and 37%; and spondylolisthesis grade I occurred in one patient. The only statistically significant difference was found for scoliosis (p < 0.01). The majority had Cobb angles <30 degrees with only two patients with curves of 35 degrees. MRI scans showed spinal stenosis in 27%, black discs in 10%, and disc protrusion in 3%. Daily back pain was reported in 17%, while 23% reported "moderate disability" as a result of back and leg pain. No patient to date has required any surgical intervention on the spine.
Except for spondylolisthesis, spinal deformities did appear to progress with time. However, this increase was not marked, and the development of relatively mild scoliosis was the only statistically significant increase. This group of patients requires continued follow-up. Further studies are required to ascertain the natural history of spinal deformity in adults with spastic diplegia who have not had SDR.
本研究旨在评估选择性背根切断术（SDR）后17 - 26年痉挛性双侧瘫患者的脊柱力学状态。
我们将早期短期随访研究的原始影像学报告与当前的X线片进行了比较。此外，我们获取了脊柱的磁共振成像（MRI）以及有关背痛和临床评估的其他信息。
30例患者（17例男性和13例女性；中位年龄26.8岁）参与了本研究，中位随访时间分别为4.0年和21.4年。X线结果比较显示：脊柱侧弯分别为0%和57%；后凸分别为0%和7%；前凸分别为21%和40%；椎弓根峡部裂分别为18%和37%；1例患者出现I度椎体滑脱。仅在脊柱侧弯方面发现有统计学意义的差异（p < 0.01）。大多数患者的Cobb角<30度，只有2例患者的侧弯角度为35度。MRI扫描显示27%存在椎管狭窄，10%存在椎间盘黑变，3%存在椎间盘突出。17%的患者报告有日常背痛，而23%的患者报告因背痛和腿痛导致“中度残疾”。迄今为止，尚无患者需要对脊柱进行任何手术干预。
除椎体滑脱外，脊柱畸形似乎确实随时间进展。然而，这种增加并不明显，相对轻度脊柱侧弯的发展是唯一有统计学意义的增加。这组患者需要持续随访。还需要进一步研究以确定未接受SDR的痉挛性双侧瘫成年患者脊柱畸形的自然病程。
