后路内固定及原位弯棒治疗特发性脊柱侧凸的颈椎矢状面排列
Cervical sagittal alignment in idiopathic scoliosis treated by posterior instrumentation and in situ bending.
作者信息
Charles Yann Philippe, Sfeir Gergi, Matter-Parrat Valérie, Sauleau Erik André, Steib Jean-Paul
机构信息
*Service de Chirurgie du Rachis, and †Service de Sante Publique, Hopitaux Universitaires de Strasbourg, Federation de Medecine Translationnelle (FMTS), Universite de Strasbourg, France.
出版信息
Spine (Phila Pa 1976). 2015 Apr 1;40(7):E419-27. doi: 10.1097/BRS.0000000000000767.
STUDY DESIGN
Retrospective radiographical analysis of cervical and thoracolumbar sagittal alignment in young adults with idiopathic scoliosis.
OBJECTIVE
To analyze cervical alignment types, the relationship between cervical and thoracolumbar alignment and the effect of posterior instrumentation.
SUMMARY OF BACKGROUND DATA
Thoracic scoliosis with hypokyphosis may decrease cervical lordosis. Additional adaptive positional changes of the mobile cervical segment may exist, because sigmoid cervical patterns are observed. Sagittal alignment of the instrumented thoracolumbar spine may influence cervical alignment.
METHODS
Pre- and postoperative full-spine radiographs of 52 patients were analyzed at 8-year average follow-up. Sagittal thoracolumbar measurements were T1 slope, T1-T4 kyphosis, T4-T12 kyphosis, L1-S1 lordosis, pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis (SVA) C7, and SVA C2. Cervical measurements were C0-C2, C2-C6, C2-C4, C4-C6, and C2-T1 lordosis, chin-brow vertical angle.
RESULTS
Five cervical alignment types were identified: lordotic, hypolordotic, kyphotic, sigmoid with cranial lordosis, and sigmoid with cranial kyphosis. Spinopelvic parameters and global thoracolumbar balance remained unchanged postoperatively. The average C2-C6 lordosis increased by 6.4° (P < 0.0001). Twenty-seven of the 52 patients changed cervical alignment postoperatively. SVA C2-C7 difference changed in this subgroup (P = 0.0159). In 21 of the 27 patients, SVA changed more than 5 mm at C2 (P = 0.0029), and in 25 of the 27 patients at C7 (P < 0.0001). A correlation existed between T4-T12 kyphosis and L1-S1 lordosis, C2-C4 and L1-S1 lordosis, L1-S1 lordosis, and pelvic tilt. T1-T4 kyphosis and T1 slope correlated with C2-T1 lordosis, but proximal junctional kyphosis was not linked to a specific cervical alignment type.
CONCLUSION
Postoperative adaptive changes occurred at C7 and C2 by shifting anteriorly or posteriorly, resulting in different radiographical cervical shapes. The amount of lumbar lordosis may influence cervical lordosis, which needs to be considered for surgical correction. Adaptive hip movements may influence thoracolumbar and cervical alignment. The amount of proximal thoracic kyphosis influenced cervical lordosis. Global thoracic hypokyphosis might influence cervical alignment, but it was not evidenced.
LEVEL OF EVIDENCE
研究设计
对患有特发性脊柱侧凸的年轻成年人的颈椎和胸腰椎矢状位排列进行回顾性影像学分析。
目的
分析颈椎排列类型、颈椎与胸腰椎排列之间的关系以及后路内固定的效果。
背景数据总结
胸椎脊柱侧凸伴后凸减少可能会降低颈椎前凸。由于观察到乙状结肠型颈椎模式，活动的颈椎节段可能存在额外的适应性位置变化。内固定胸腰椎脊柱的矢状位排列可能会影响颈椎排列。
方法
对52例患者术前和术后的全脊柱X线片进行分析，平均随访8年。胸腰椎矢状位测量指标包括T1斜率、T1 - T4后凸、T4 - T12后凸、L1 - S1前凸、骨盆入射角、骨盆倾斜度、骶骨斜率、C7矢状垂直轴（SVA）和C2矢状垂直轴。颈椎测量指标包括C0 - C2、C2 - C6、C2 - C4、C4 - C6以及C2 - T1前凸、颏眉垂直角。
结果
确定了五种颈椎排列类型：前凸型、前凸减少型、后凸型、颅侧前凸的乙状结肠型和颅侧后凸的乙状结肠型。术后脊柱 - 骨盆参数和整体胸腰椎平衡保持不变。平均C2 - C6前凸增加了6.4°（P < 0.0001）。52例患者中有27例术后颈椎排列发生改变。该亚组中SVA C2 - C7差值发生了变化（P = 0.0159）。27例患者中有21例C2处的SVA变化超过5 mm（P = 0.0029），27例患者中有25例C7处的SVA变化超过5 mm（P < 0.0001）。T4 - T12后凸与L1 - S1前凸、C2 - C4与L1 - S1前凸、L1 - S1前凸与骨盆倾斜度之间存在相关性。T1 - T4后凸和T1斜率与C2 - T1前凸相关，但近端交界性后凸与特定的颈椎排列类型无关。
结论
术后C7和C2通过向前或向后移位发生适应性变化，导致不同的颈椎影像学形态。腰椎前凸的程度可能会影响颈椎前凸，手术矫正时需要考虑这一点。适应性髋关节运动可能会影响胸腰椎和颈椎排列。近端胸椎后凸的程度影响颈椎前凸。整体胸椎后凸减少可能会影响颈椎排列，但未得到证实。
证据级别
4级。
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