Wang Fei, Zhou Xiao-Yi, Xu Xi-Ming, Yang Yi-Lin, Zhu Xiao-Dong, Bai Yu-Shu, Li Ming, Wei Xian-Zhao
Department of Orthopaedic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Spine (Phila Pa 1976). 2017 May 1;42(9):E539-E546. doi: 10.1097/BRS.0000000000001906.
A retrospective clinical and radiographic study.
The aim of this study was to analyze the radiographic change in cervical sagittal alignment (CSA) and identify the possible factors influencing the postoperative CSA in selective posterior thoracolumbar/lumbar (TL/L) curve correction.
The correlation between the CSA and thoracic sagittal alignment (TSA) is a well-recognized phenomenon in patients with thoracic idiopathic scoliosis. However, little has been published about the influence of TL/L curve instrumentation on CSA.
Thirty patients with Lenke type 5C adolescent idiopathic scoliosis (AIS) received the selective posterior TL/L curves fusion by pedicle screws. Preoperative and postoperative radiographic and clinical parameters were analyzed. C2-C7 lordosis less than 0 was considered a lordotic cervical spine (LCS), whereas more than 0 was considered a kyphotic cervical spine (KCS).
Preoperatively, 43% of patients showed a KCS, whereas the remaining 57% showed a LCS. C2-C7 lordosis was correlated with T1-slope, thoracic kyphosis (TK), and global-TK (Gl-TK) (P < 0.05). The patients in the KCS group showed a smaller T1-slope, TK, and Gl-TK than those in the LCS group. Logistic regression analysis revealed that the T1-slope [odds ratio (OR) = 0.86, P = 0.008] and Gl-TK (OR = 0.90, P = 0.019) were risk factors for developing KCS. In the LCS group, 5 of 12 patients with LCS exhibited KCS after surgery. The T1-slope and Gl-TK in the changed group were considerably smaller than those in the maintained group (P = 0.004 and 0.035, respectively). In the KCS group, 6 of 13 patients with KCS unrecovered to LCS after the operation. The T1-slope in the unrecovered group was smaller than that in the recovered group (P = 0.045).
C2-C7 lordosis was strongly correlated with the T1-slope. C2-C7 lordosis of Lenke 5C AIS was related to the global TSA rather than TK and proximal TK. As time progresses, spontaneous adjustment of CSA is limited because of the inherent rigidity of the cervical spine.
一项回顾性临床和影像学研究。
本研究旨在分析颈椎矢状面排列（CSA）的影像学变化，并确定在选择性胸腰段/腰椎（TL/L）曲线矫正中影响术后CSA的可能因素。
在特发性胸椎脊柱侧凸患者中，CSA与胸椎矢状面排列（TSA）之间的相关性是一个公认的现象。然而，关于TL/L曲线内固定对CSA的影响，鲜有文献报道。
30例Lenke 5C型青少年特发性脊柱侧凸（AIS）患者接受了经椎弓根螺钉选择性后路TL/L曲线融合术。分析术前和术后的影像学及临床参数。C2-C7前凸小于0被认为是前凸颈椎（LCS），而大于0被认为是后凸颈椎（KCS）。
术前，43%的患者表现为KCS，其余57%表现为LCS。C2-C7前凸与T1斜率、胸椎后凸（TK）和整体胸椎后凸（Gl-TK）相关（P<0.05）。KCS组患者的T1斜率、TK和Gl-TK均小于LCS组。逻辑回归分析显示，T1斜率[比值比（OR）=0.86，P=0.008]和Gl-TK（OR=0.90，P=0.019）是发生KCS的危险因素。在LCS组中，12例LCS患者中有5例术后出现KCS。变化组的T1斜率和Gl-TK明显小于维持组（分别为P=0.004和0.035）。在KCS组中，13例KCS患者中有6例术后未恢复至LCS。未恢复组的T1斜率小于恢复组（P=0.045）。
C2-C7前凸与T1斜率密切相关。Lenke 5C型AIS的C2-C7前凸与整体TSA相关，而非与TK和近端TK相关。随着时间的推移，由于颈椎的固有刚性，CSA的自发调整是有限的。
4级。
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