Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
Orthop Surg. 2009 Nov;1(4):285-92. doi: 10.1111/j.1757-7861.2009.00051.x.
To investigate the effect of interbody cage support on reconstruction of the sagittal profile after anterior selective correction in Lenke type 5 adolescent idiopathic scoliosis (AIS) patients.
In this retrospective study, a total of 40 AIS patients with a Lenke type 5 curve who underwent anterior selective fusion (ASF) using a single rod were studied. They were divided into two groups: Group A, bone grafting with an interbody titanium mesh cage (TMC); and Group B, bone grafting without a TMC. There were 19 female and 1 male patient aged 12-18 years in Group A, and 17 female and 3 male patients aged 13-20 years in Group B. All patients were followed up for more than 18 months. The coronal correction of the scoliosis and reconstruction of the sagittal profile were evaluated retrospectively.
By final follow-up, more than 70% correction had been achieved for the primary curve and a spontaneous correction for the secondary curve in both groups. Satisfactory reconstructions on the sagittal plane were also observed. Similar changes were found in Group A and Group B, including increases in thoracic kyphosis, slight changes in thoracolumbar junctional kyphosis, no significant losses of lumbar lordosis, mild increases in proximal junctional measurement, and remarkable lordosis losses in the instrumented segments. With lessening of the sagittal balance and L(1) offset, a significant anterior shift of the C(7) plumb line was noted during follow-up in Group A, indicating a more balanced spine in this group.
Anterior selective single rod instrumentation and fusion is a recommended method for Lenke type 5C AIS. A structural interbody cage does not appear to improve the regional profile, nor the profiles in the instrumented area and the adjacent proximal and distal segments; yet could result in a better total balance in the long-term.
研究在 Lenke 型 5 型青少年特发性脊柱侧凸（AIS）患者中，前路选择性矫正后椎间笼支撑对矢状位重建的影响。
在这项回顾性研究中，共研究了 40 例采用单棒行前路选择性融合（ASF）的 Lenke 型 5 型曲线 AIS 患者。他们分为两组：A 组，椎间钛网笼植骨（TMC）；B 组，单纯植骨。A 组有 19 名女性和 1 名男性，年龄 12-18 岁，B 组有 17 名女性和 3 名男性，年龄 13-20 岁。所有患者均随访超过 18 个月。回顾性评估脊柱侧凸的冠状矫正和矢状位重建情况。
末次随访时，两组主弯均获得超过 70%的初始矫正，继发弯获得自发矫正。矢状面也观察到满意的重建。A 组和 B 组的变化相似，包括胸椎后凸增加，胸腰连接区后凸轻微变化，腰椎前凸无明显丢失，近端交界测量值轻度增加，器械节段显著后凸丢失。随着矢状位平衡和 L1 偏移的减少，A 组在随访过程中 C7 铅垂线明显向前移位，表明该组脊柱更平衡。
前路选择性单棒器械和融合是 Lenke 型 5C AIS 的推荐方法。结构性椎间笼似乎不能改善区域形态，也不能改善器械区和相邻近端及远端节段的形态；但在长期随访中可能会导致整体平衡更好。
