Department of Orthopedics, Rady Children's Hospital, San Diego, CA, USA.
Spine (Phila Pa 1976). 2012 May 1;37(10):826-32. doi: 10.1097/BRS.0b013e31823b4eab.
A cross-sectional study.
The purpose of this study was to assess intervertebral segmental and cumulative motion in the distal unfused segments of the spine in patients with adolescent idiopathic scoliosis after instrumentation as a function of the lowest instrumented level.
The implications of hyper- or hypomobility in the unfused segments of the spine after instrumentation are poorly understood. There is little research on changes in functional movement capabilities of the spine after thoracolumbar spinal fusion.
Patients were prospectively offered inclusion into this institutional review board-approved cross-sectional study at their routine 2-, 3-, 4-, or 5-year postoperative visits at 1 of the 5 participating centers. Motion was assessed by standardized radiographs acquired in maximum right, left and forwarding bending positions. The intervertebral angles were measured via digital radiographic measuring software at each level from T12 to S1. The relationship of the vertebral segmental motion for each interspace to the lowest instrumented vertebrae was evaluated with an analysis of variance. The relationship between the cumulative preserved motion and each domain of the Scoliosis Research Society questionnaire were evaluated using a Pearson correlation coefficient.
The data for 100 patients are included. The lowest instrumented vertebrae ranged from T10 to L4. In lateral bending, an association was detected between the lowest fused vertebral level and the degree of motion at the distal unfused segments. With a more distal instrumented vertebrae, there was significantly greater L2-L3, L3-L4, and L4-L5 segment motion (P = 0.002, 0.009, and 0.001, respectively). A similar trend was noticed at L5-S1 level. In addition, the summed motion from L3 to S1 also increased with a more distal fusion (P = 0.001). Similar results were not found in forward bending. None of the domains of the Scoliosis Research Society questionnaire correlated with the preserved L3-S1 motion.
In a group of postoperative patients with adolescent idiopathic scoliosis, evaluation of the distal unfused intervertebral motion showed that preservation of vertebral motion segments allowed greater distribution of functional motion across more levels. With each distal fusion level, motion was significantly increased at the L2-L3, L3-L4, and L4-L5 segmental levels in lateral bending. The relationship between the increased motion and subsequent disc degeneration with a more distal fusion is unknown, but suspected.
一项横断面研究。
本研究的目的是评估青少年特发性脊柱侧凸患者脊柱未融合节段的节段性和累积运动，作为最低融合节段的功能。
对脊柱未融合节段过度活动或活动不足的影响知之甚少。关于胸腰椎融合后脊柱功能运动能力变化的研究甚少。
在 5 个参与中心的 2 年、3 年、4 年或 5 年常规术后随访时，前瞻性地向患者提供本机构审查委员会批准的横断面研究纳入。通过在最大右侧、左侧和前屈位置获得的标准 X 光片评估运动。在 T12 到 S1 的每个节段，通过数字放射测量软件测量椎间角度。通过方差分析评估每个椎间的椎体节段运动与最低融合椎骨的关系。使用 Pearson 相关系数评估累积保留运动与脊柱侧凸研究协会问卷各领域的关系。
纳入 100 例患者的数据。最低融合椎骨范围从 T10 到 L4。在侧屈时，最低融合椎体水平与未融合节段远端运动程度之间存在关联。随着融合椎骨更向远端，L2-L3、L3-L4 和 L4-L5 节段的运动显著增加（P = 0.002、0.009 和 0.001）。在 L5-S1 水平也观察到类似的趋势。此外，随着融合的更远端，从 L3 到 S1 的总运动也增加（P = 0.001）。前屈时未发现类似结果。脊柱侧凸研究协会问卷的任何领域都与保留的 L3-S1 运动无关。
在一组青少年特发性脊柱侧凸术后患者中，对未融合的脊柱间运动的评估表明，保留椎体运动节段允许更多的功能运动分布在更多的水平上。在侧屈时，随着融合节段向远端每增加一个节段，L2-L3、L3-L4 和 L4-L5 节段的运动明显增加。随着融合节段向远端增加，运动与随后的椎间盘退变之间的关系尚不清楚，但值得怀疑。
