Delfino Renato, Pizones Javier, Ruiz-Juretschke Cristina, Sánchez-Mariscal Felisa, Zúñiga Lorenzo, Izquierdo Enrique
Spine Unit, Department of Orthopedic Surgery, Hospital Universitario de Getafe, Madrid, Spain.
Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain.
Spine (Phila Pa 1976). 2017 Jul 1;42(13):E788-E794. doi: 10.1097/BRS.0000000000001973.
Prospectively updated long-term data and retrospective case series analysis.
To report the long-term results of selective anterior instrumented thoracolumbar (ThL) fusion in adolescent idiopathic scoliosis (AIS).
The results of anterior selective fusion in AIS have been reported up to 2 and 5 years follow-up. However, there is a lack of evidence of long-term results of this surgical approach.
Forty-two consecutive patients with main thoracolumbar/lumbar AIS who had undergone surgery for a selective anterior ThL instrumented fusion with more than 12 years of follow-up met inclusion criteria. Preoperative, postoperative (1-yr), and final updated radiographic parameters were recorded. Final ODI and SRS-22 questionnaires were evaluated.
Thirty-five patients were finally recruited (5 were lost and 2 refused). The mean age at surgery was 16.6 years. The mean final follow-up was 17.3 years (12-24 yr).The ThL preoperative Cobb was 49.5° ± 9, obtaining a postoperative correction of 79%±13 and final correction of 72% ± 18. The preoperative thoracic curve (31.4° ± 14.2) obtained a spontaneous postoperative correction to 18.4° ± 11.9, maintained at final follow-up (17.8° ± 10.8). Apical vertebral rotation improved from 25.8° ± 7.8 to 9.2° ± 5.5 and finally to 8° ± 5.2 (P = 0.001). Sagittal parameters (T5-T12 = 27.2° and L1-S1=56.9°) did not change significantly postoperatively nor by final follow-up. Coronal balance improved from 2.4 cm to 1.6 cm postoperatively and 0.8 cm at final follow-up (P = 0.006). The disc angulation below the last instrumented vertebra improved with follow-up from 7.6° to 5.7° (P = 0.012).There were no revision surgeries or infections. One patient showed a symptomatic lower disc degeneration requiring lumbar pain surgery. Final SRS-22 global score was 4.3/5. The final ODI scored 6/100.
In the long term, selective anterior thoracolumbar instrumentation with a single solid rod in AIS maintained good corrections on the three planes with no major complications or infections, no revision surgeries, and with satisfactory final functional and clinical outcomes.
前瞻性更新的长期数据及回顾性病例系列分析。
报告青少年特发性脊柱侧凸（AIS）患者选择性前路胸腰段（ThL）融合内固定术的长期疗效。
已有关于AIS患者前路选择性融合术2年及5年随访结果的报道。然而，缺乏该手术方式长期疗效的证据。
42例连续的主要为胸腰段/腰段AIS患者接受了选择性前路ThL融合内固定术，随访时间超过12年，符合纳入标准。记录术前、术后（1年）及最终更新的影像学参数。评估最终ODI和SRS-22问卷。
最终纳入35例患者（5例失访，2例拒绝）。手术时的平均年龄为16.6岁。平均最终随访时间为17.3年（12 - 24年）。ThL术前Cobb角为49.5°±9°，术后矫正率为79%±13%，最终矫正率为72%±18%。术前胸椎曲线（31.4°±14.2°）术后自发矫正至18.4°±11.9°并在最终随访时维持（17.8°±10.8°）。顶椎旋转度从25.8°±7.8°改善至9.2°±5.5°，最终至8°±5.2°（P = 0.001）。矢状面参数（T5 - T12 = 27.2°，L1 - S1 = 56.9°）术后及最终随访时均无显著变化。冠状面平衡术后从2.4 cm改善至1.6 cm，最终随访时为0.8 cm（P = 0.006）。最后一枚固定椎体下方的椎间盘成角随随访从7.6°改善至5.7°（P = 0.012）。无翻修手术或感染发生。1例患者出现有症状的下位椎间盘退变，需要进行腰椎疼痛手术。最终SRS - 22总体评分为4.3/5。最终ODI评分为6/100。
长期来看，AIS患者采用单根坚固棒的选择性前路胸腰段内固定术在三个平面上均维持了良好的矫正效果，无重大并发症或感染，无需翻修手术，最终功能和临床结局令人满意。
4级。
