Hwang Steven W, Safain Mina G, King Joseph J, Kimball Jeff S, Ames Robert, Betz Randall R, Cahill Patrick J, Samdani Amer F
Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts; and.
J Neurosurg Spine. 2015 Feb;22(2):185-91. doi: 10.3171/2014.10.SPINE14185. Epub 2014 Nov 21.
Almost all pediatric patients who incur a spinal cord injury (SCI) will develop scoliosis, and younger patients are at highest risk for curve progression requiring surgical intervention. Although the use of pedicle screws is increasing in popularity, their impact on SCI-related scoliosis has not been described. The authors retrospectively reviewed the radiographic outcomes of pedicle screw-only constructs in all patients who had undergone SCI-related scoliosis correction at a single institution.
Medical records and radiographs from Shriner's Hospital for Children-Philadelphia for the period between November 2004 and February 2011 were retrospectively reviewed.
Thirty-seven patients, whose mean age at the index surgery was 14.91±3.29 years, were identified. The cohort had a mean follow-up of 33.2±22.8 months. The mean preoperative coronal Cobb angle was 65.5°±25.7°, which corrected to 20.3°±14.4°, translating into a 69% correction (p<0.05). The preoperative coronal balance was 24.4±22.6 mm, with a postoperative measurement of 21.6±20.7 mm (p=1.00). Preoperative pelvic obliquity was 12.7°±8.7°, which corrected to 4.1°±3.8°, translating into a 68% correction (p<0.05). Preoperative shoulder balance, as measured by the clavicle angle, was 8.2°±8.4°, which corrected to 2.7°±3.1° (67% correction, p<0.05). Preoperatively, thoracic kyphosis measured 44.2°±23.7° and was 33.8°±11.5° postoperatively. Thoracolumbar kyphosis was 18.7°±12.1° preoperatively, reduced to 8.1°±7.7° postoperatively, and measured 26.8°±20.2° at the last follow-up (p<0.05). Preoperatively, lumbar lordosis was 35.3°±22.0°, which remained stable at 35.6°±15.0° postoperatively.
Pedicle screw constructs appear to provide better correction of coronal parameters than historically reported and provide significant improvement of sagittal kyphosis as well. Although pedicle screws appear to provide good radiographic results, correlation with clinical outcomes is necessary to determine the true impact of pedicle screw constructs on SCI-related scoliosis correction.
几乎所有脊髓损伤（SCI）的儿科患者都会发展为脊柱侧弯，而较年轻的患者发生侧弯进展并需要手术干预的风险最高。尽管椎弓根螺钉的使用越来越普遍，但它们对SCI相关性脊柱侧弯的影响尚未见描述。作者回顾性分析了在单一机构接受SCI相关性脊柱侧弯矫正的所有患者中仅使用椎弓根螺钉固定的影像学结果。
回顾性分析了2004年11月至2011年2月期间费城儿童医院施莱宁分院的病历和X线片。
共纳入37例患者，初次手术时的平均年龄为14.91±3.29岁。队列的平均随访时间为33.2±22.8个月。术前冠状面Cobb角平均为65.5°±25.7°，矫正后为20.3°±14.4°，矫正率为69%（p<0.05）。术前冠状面平衡为24.4±22.6mm，术后测量为21.6±20.7mm（p=1.00）。术前骨盆倾斜度为12.7°±8.7°，矫正后为4.1°±3.8°，矫正率为68%（p<0.05）。术前通过锁骨角测量的肩部平衡为8.2°±8.4°，矫正后为2.7°±3.1°（矫正率67%，p<0.05）。术前胸椎后凸角度为44.2°±23.7°，术后为33.8°±11.5°。胸腰段后凸术前为18.7°±12.1°，术后降至8.1°±7.7°，末次随访时为26.8°±20.2°（p<0.05）。术前腰椎前凸为35.3°±22.0°，术后保持稳定，为35.6°±15.0°。
与既往报道相比，椎弓根螺钉固定似乎能更好地矫正冠状面参数，也能显著改善矢状面后凸。尽管椎弓根螺钉似乎能提供良好的影像学结果，但需要将其与临床结果相关联，以确定椎弓根螺钉固定对SCI相关性脊柱侧弯矫正的真正影响。
