*University of Connecticut †Center for Motion Analysis, and ‡Orthopaedic and Sports Medicine Research Department, Connecticut Children's Medical Center, Hartford, CT; and §Yale University, Yale-New Haven Hospital, New Haven, CT.
Spine (Phila Pa 1976). 2013 Oct 15;38(22):E1405-10. doi: 10.1097/BRS.0b013e3182a4038b.
Prospective study.
Evaluate the impact of the distal fusion level on overall spine motion in patients with adolescent idiopathic scoliosis.
In the surgical treatment of adolescent idiopathic scoliosis, the impact of incorporating a single additional distal lumbar fusion level on residual spinal motion is unclear. This study uses radiographs and computerized motion capture technology to determine whether the addition of a single lumbar level in a posterior fusion construct produces a detectable alteration in spinal motion.
Twenty-three patients with adolescent idiopathic scoliosis were evaluated with standing radiographs and computerized motion analysis preoperatively and 1 year after fusion. Patients were divided into 2 groups: L1-L2 group (distal fusion ended at L1-L2) and an L3 group (distal fusion ended at L3). Cobb angle, coronal vertical alignment, sagittal vertical alignment, thoracic kyphosis, and lumbar lordosis were measured from radiographs. Three-dimensional motion data were obtained for static standing and repeated bending or twisting motions. Statistical analysis was performed with Student t test, analysis of variance, and Fisher exact methods.
Both the L1-L2 and L3 groups demonstrated loss of spinal motion compared with preoperative values. The L1-L2 group showed a significant loss of rotational motion but no significant loss of motion in the sagittal and coronal planes. The L3 group demonstrated significant loss of motion in both the coronal plane and the rotational plane. When the 2 groups were compared, the L3 group showed a significant loss of coronal plane bending (18° ± 10°, P = 0.002).
Distal extension of a posterior spinal fusion construct to include L3 results in a significant decrease in spine motion in at least one plane. Preservation of a single lumbar segment may improve overall spine motion in the short term and may have implications for the long-term health of the unfused spine.
前瞻性研究。
评估青少年特发性脊柱侧凸患者远端融合水平对整体脊柱运动的影响。
在青少年特发性脊柱侧凸的手术治疗中，加入单个额外的腰椎远端融合对残余脊柱运动的影响尚不清楚。本研究使用影像学和计算机运动捕捉技术来确定在后路融合结构中增加单个腰椎水平是否会导致脊柱运动产生可检测的改变。
23 例青少年特发性脊柱侧凸患者在术前和融合后 1 年进行站立位影像学和计算机运动分析评估。患者分为 L1-L2 组（远端融合止于 L1-L2）和 L3 组（远端融合止于 L3）。从影像学上测量 Cobb 角、冠状面垂直alignment、矢状面垂直alignment、胸椎后凸和腰椎前凸。获得三维运动数据，用于静态站立和反复弯曲或扭曲运动。使用学生 t 检验、方差分析和 Fisher 精确检验进行统计分析。
L1-L2 组和 L3 组与术前相比均出现脊柱运动丧失。L1-L2 组旋转运动明显丧失，但冠状面和矢状面运动无明显丧失。L3 组在冠状面和旋转面均表现出明显的运动丧失。当两组进行比较时，L3 组在冠状面弯曲运动方面明显丧失（18°±10°，P=0.002）。
后路脊柱融合结构的远端延伸至 L3 会导致至少一个平面的脊柱运动明显减少。保留单个腰椎节段可能会在短期内改善整体脊柱运动，并可能对未融合脊柱的长期健康产生影响。
3 级。
