Department of Orthopedics, Rady Children's Hospital-San Diego, CA, USA.
Spine (Phila Pa 1976). 2010 Jun 15;35(14):1365-70. doi: 10.1097/BRS.0b013e3181dccd63.
Retrospective analysis of prospectively collected multicenter series.
To evaluate the sagittal profile of surgically treated adolescent idiopathic scoliosis (AIS) patients.
With the increasing popularity of segmental pedicle screw spinal instrumentation, thoracic kyphosis (TK) is often sacrificed to achieve coronal and axial plane correction.
Radiographs of AIS patients with a Lenke type 1 deformity and minimum 2-year follow-up after selective thoracic fusion (lowest instrumented vertebra of T11, T12, or L1) were evaluated. Changes in TK were correlated with changes in lumbar lordosis (LL). Patients were divided according to approach (open/thoracoscopic anterior vs. posterior). Analysis of variance was used to compare pre and postoperative radiographic measures.
Two hundred fifty-one patients (age: 14 +/- 2 years) were included. Sixty seven percentages of the patients had anterior surgery (97 open anterior, 71 thoracoscopic) and 33% (83 patients) had posterior spinal fusion. A decrease in postoperative TK was significantly correlated (P < or = 0.001) with a decrease in LL at first erect (r = 0.3), 1 year (r = 0.4) and 2 years (r = 0.4), independent of surgical approach. LL decreased significantly at the first erect regardless of approach (P = 0.003); however, at 2-year postoperative TK and LL were significantly decreased after a posterior approach (P < or = 0.001) when compared with an anterior approach that added kyphosis. The decrease in LL (5.6 degrees +/- 9.7 degrees) was nearly twice the decrease in TK (2.8 degrees +/- 11.4 degrees) in the posterior group at 2-years.
Given that thoracic AIS is often associated with a preexisting reduction in TK, ideal surgical correction should address this deformity. Procedures which further reduce TK also reduce LL. It is unclear if the loss of LL from thoracic scoliosis correction will compound the loss of LL that occurs with age and lead to further decline in sagittal balance. With this concern, we recommend a posterior column lengthening and/or an anterior column shortening to achieve restoration of normal TK and maximal LL.
前瞻性收集的多中心系列回顾性分析。
评估手术治疗青少年特发性脊柱侧凸（AIS）患者的矢状面轮廓。
随着节段性椎弓根螺钉脊柱器械的日益普及，为了实现冠状面和轴向平面的矫正，胸椎后凸（TK）通常被牺牲。
评估具有 Lenke 1 型畸形的 AIS 患者的影像学资料，这些患者在选择性胸椎融合术后至少有 2 年的随访（最低固定椎为 T11、T12 或 L1）。TK 的变化与腰椎前凸（LL）的变化相关。根据入路（前路开放/胸腔镜 vs. 后路）将患者进行分组。采用方差分析比较术前和术后影像学测量值。
共纳入 251 例患者（年龄：14 +/- 2 岁）。67%的患者接受了前路手术（97 例前路开放手术，71 例胸腔镜手术），33%（83 例）接受了后路脊柱融合术。术后 TK 的减少与初次直立时 LL 的减少显著相关（P < or = 0.001）（r = 0.3）、1 年时（r = 0.4）和 2 年时（r = 0.4），与手术入路无关。无论入路如何，初次直立时 LL 均显著减少（P = 0.003）；然而，后路入路术后 2 年时 TK 和 LL 明显减少（P < or = 0.001），而前路入路则增加了后凸。后路组在 2 年时，LL 的减少（5.6 度 +/- 9.7 度）几乎是 TK 减少（2.8 度 +/- 11.4 度）的两倍。
鉴于胸段 AIS 常伴有 TK 预先存在的减少，理想的手术矫正应解决这种畸形。进一步减少 TK 的手术也会减少 LL。尚不清楚胸椎脊柱侧凸矫正引起的 LL 减少是否会与年龄相关的 LL 减少相叠加，从而导致矢状面平衡进一步恶化。考虑到这一点，我们建议进行后路后柱延长和/或前柱缩短，以恢复正常的 TK 和最大的 LL。
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