Erken H Yener, Burc Halil, Saka Gursel, Aydogan Mehmet
Department of Orthopaedic Surgery, Anadolu Medical Center, Cumhuriyet Mahallesi 2255 Sokak No. 3 Gebze, 41400, Kocaeli, Turkey,
Eur Spine J. 2014 Jun;23(6):1258-62. doi: 10.1007/s00586-014-3278-y. Epub 2014 Mar 25.
Determining a surgical plan for the treatment of adolescent idiopathic scoliosis (AIS) can be challenging. Despite treatment recommendations and classification systems (such as the Lenke classification system) there is still no consensus on the optimal surgical plan for each curve type. The main objective of this study is to analyze the disagreements in surgical planning between spinal surgeons in AIS.
In a monthly meeting, four orthopaedic spine surgeons from different institutions analyzed a consecutive series of AIS patients. The differences in surgical plans were evaluated for each patient. The primary physician of the patient presented the case and specifically stated the Lenke type of the deformity in the presentation. We wanted to specifically document the disagreements between surgeons despite knowing the Lenke type of the deformity.
One hundred consecutive AIS patients were reviewed over a 10-month period. There was a difference of at least one surgical plan from at least one surgeon in 31 of the cases; 30 of these disagreements in surgical planning were about fusion levels; 19 of these 30 disagreements were in only the upper instrumented vertebra (UIV), while seven were disagreements in only the lowest instrumented vertebra (LIV). In four cases, both the UIV and LIV levels varied.
There was at least one difference in surgical planning in 31 of the 100 cases (31 %). This shows that despite treatment algorithms and the Lenke classification system, disagreements in surgical planning still exist between spinal surgeons.
确定青少年特发性脊柱侧凸（AIS）的手术治疗方案具有挑战性。尽管有治疗建议和分类系统（如Lenke分类系统），但对于每种曲线类型的最佳手术方案仍未达成共识。本研究的主要目的是分析AIS脊柱外科医生在手术规划上的分歧。
在每月一次的会议上，来自不同机构的四位骨科脊柱外科医生分析了一系列连续的AIS患者。评估了每位患者手术方案的差异。患者的主治医生介绍病例，并在介绍中明确说明畸形的Lenke类型。我们想特别记录外科医生之间的分歧，尽管已知畸形的Lenke类型。
在10个月的时间里，对100例连续的AIS患者进行了评估。在31例病例中，至少有一位外科医生的手术方案存在至少一处差异；这些手术规划分歧中有30处是关于融合节段的；这30处分歧中有19处仅在上端椎（UIV），而7处仅在下端椎（LIV）存在分歧。在4例病例中，UIV和LIV节段均有变化。
100例病例中有31例（31%）在手术规划上至少存在一处差异。这表明，尽管有治疗算法和Lenke分类系统，脊柱外科医生在手术规划上仍存在分歧。
