青少年特发性脊柱侧凸中椎间盘与椎体扭转及不对称性的三维特征
Three-dimensional characterization of torsion and asymmetry of the intervertebral discs versus vertebral bodies in adolescent idiopathic scoliosis.
作者信息
Schlösser Tom P C, van Stralen Marijn, Brink Rob C, Chu Winnie C W, Lam Tsz-Ping, Vincken Koen L, Castelein René M, Cheng Jack C Y
机构信息
*Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands †Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands; and ‡Departments of Diagnostic Radiology and Organ Imaging and §Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
出版信息
Spine (Phila Pa 1976). 2014 Sep 1;39(19):E1159-66. doi: 10.1097/BRS.0000000000000467.
STUDY DESIGN
Cross-sectional study.
OBJECTIVE
To compare the relative contribution of the vertebral bodies and intervertebral discs with the 3-dimensional spinal deformity in adolescent idiopathic scoliosis.
SUMMARY OF BACKGROUND DATA
There is an ongoing discussion about the causal role of skeletal growth processes in the etiopathogenesis of adolescent idiopathic scoliosis. Contradictory findings have been reported on the individual contribution of the vertebral bodies as compared with the discs to the coronal deformity. As far as we know, the true 3-dimensional deformity of the discs and vertebral bodies have not yet been described.
METHODS
High-resolution computed tomographic scans of 77 patients with severe adolescent idiopathic scoliosis were included. Torsion and anterior-posterior and right-left asymmetry of each individual vertebral body and intervertebral disc were studied from T2 to L5, using semiautomatic analysis software. True transverse sections were reconstructed along the anterior-posterior and right-left axis of all endplates. These "endplate-vectors" were calculated semiautomatically, taking rotation and tilt into account. Torsion was defined as the difference in axial rotation between 2 subsequent endplates. Asymmetry was defined as the relative anterior-posterior or right-left height difference of the discs and the vertebrae.
RESULTS
There were at least 3 times more torsion, anterior overgrowth, and coronal wedging in the discs than in the vertebrae in the thoracic as well as in the (thoraco) lumbar curves (P<0.001). These values correlated significantly with the Cobb angle (r≥0.37; P<0.001). Anterior overgrowth and coronal asymmetry were greater in the apical regions whereas torsion was most pronounced in the transitional segments between the curves.
CONCLUSION
The discs contribute more to 3-D deformity than the bony structures, and there is significant regional variability. This suggests an adaptive rather than an active phenomenon.
LEVEL OF EVIDENCE
研究设计
横断面研究。
目的
比较青少年特发性脊柱侧凸中椎体和椎间盘对三维脊柱畸形的相对贡献。
背景资料总结
关于骨骼生长过程在青少年特发性脊柱侧凸发病机制中的因果作用，目前仍在讨论中。关于椎体与椎间盘对冠状面畸形的个体贡献，已有相互矛盾的研究结果报道。据我们所知，椎间盘和椎体的真正三维畸形尚未被描述。
方法
纳入77例重度青少年特发性脊柱侧凸患者的高分辨率计算机断层扫描图像。使用半自动分析软件，研究从T2至L5每个椎体和椎间盘的扭转、前后不对称及左右不对称情况。沿所有终板的前后轴和左右轴重建真实横断面。这些“终板向量”在考虑旋转和倾斜的情况下进行半自动计算。扭转定义为两个相邻终板之间的轴向旋转差异。不对称定义为椎间盘和椎体相对的前后或左右高度差异。
结果
在胸椎及胸腰段曲线中，椎间盘的扭转、前方过度生长和冠状面楔形变至少是椎体的3倍（P<0.001）。这些值与Cobb角显著相关（r≥0.37；P<0.001）。顶端区域的前方过度生长和冠状面不对称更大，而扭转在曲线间的过渡节段最为明显。
结论
椎间盘对三维畸形的贡献大于骨性结构，且存在显著的区域差异。这表明这是一种适应性而非主动性现象。
证据水平
2级。
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