Hosseini Pooria, Nnadi Colin, Rehák Ľuboš, Repko Martin, Grevitt Michael, Aydinli Ufuk, Carl Allen, Pawelek Jeff, Crandall Dennis, Akbarnia Behrooz A
San Diego Spine Foundation, San Diego, CA.
Nuffield Orthopaedic Centre, Oxford University Hospital, Oxford, UK.
Spine (Phila Pa 1976). 2016 Oct 15;41(20):E1223-E1229. doi: 10.1097/BRS.0000000000001607.
A prospective, nonrandomized, multicenter study.
The purpose of this study was to evaluate the amount of motion present at instrumented but unfused segments and at motion segments adjacent to the instrumentation following application of a new posterior apical short-segment correction technique for correcting adolescent idiopathic scoliosis (AIS).
High-density pedicle screw instrumentation and posterior arthrodesis of all instrumented levels is the most common surgical treatment for AIS stabilization. The consequence of long fusion is an abnormal load on adjacent levels with an increased risk of future adjacent segment degeneration.
This new system applied translational and derotational forces over a short apical segment. The short apical region was prepared for fusion while maintaining motion of unfused vertebral segments. Radiographic data were collected pre-operatively, at surgery, and at 3, 6, and 12 months after surgery.
Twenty-one female patients, mean age of 14.2 years (10.6-16.9 years) with Lenke 1A/1B curves, were enrolled. The range of motion in the unfused instrumented segment was significantly higher than the apical fused segment (11 vs. 0.9, P < 0.001). The range of motion of unfused vertebral levels distal to the construct at one year did not differ significantly from their respective pre-op values. When the analysis was extended to understand the impact of lower instrumented vertebra (LIV) on motion of unfused segments distal to the construct, it appeared that (1) the change in motion from pre-op to 12 months post-op as a function of LIV is not statistically significant; and (2) The motion of the unfused distal vertebral segments at 12 months does not statistically increase with a lower LIV.
Through one year, this novel technique achieved and maintained similar AIS correction to current posterior fusion techniques while maintaining the mobility of unfused motion segments with less implant density.
一项前瞻性、非随机、多中心研究。
本研究的目的是评估在应用一种新的后路顶椎短节段矫正技术治疗青少年特发性脊柱侧凸（AIS）后，固定但未融合节段以及固定节段相邻活动节段的活动量。
所有固定节段的高密度椎弓根螺钉内固定和后路融合术是AIS稳定治疗最常见的手术方式。长节段融合的后果是相邻节段承受异常负荷，未来相邻节段退变风险增加。
该新系统在短顶椎节段施加平移和去旋转力。在保持未融合椎体节段活动的同时，准备短顶椎区域进行融合。术前、术中以及术后3个月、6个月和12个月收集影像学数据。
纳入21例Lenke 1A/1B型曲线的女性患者，平均年龄14.2岁（10.6 - 16.9岁）。未融合固定节段的活动范围显著高于顶椎融合节段（11对0.9，P<0.001）。术后1年，固定结构远端未融合椎体节段的活动范围与各自术前值相比无显著差异。当分析扩展以了解下位固定椎体（LIV）对固定结构远端未融合节段活动的影响时，似乎（1）从术前到术后12个月活动的变化作为LIV的函数无统计学意义；（2）术后12个月未融合远端椎体节段的活动不会随更低的LIV而在统计学上增加。
经过一年时间，这项新技术实现并维持了与当前后路融合技术相似的AIS矫正效果，同时以更低的植入物密度保持了未融合活动节段的活动度。
4级。
