Brink Rob C, Schlösser Tom P C, Colo Dino, Vincken Koen L, van Stralen Marijn, Hui Steve C N, Chu Winnie C W, Cheng Jack C Y, Castelein René M
Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.
Spine Deform. 2017 Jan;5(1):37-45. doi: 10.1016/j.jspd.2016.08.006.
Cross-sectional.
To quantify the asymmetry of the vertebral bodies and pedicles in the true transverse plane in adolescent idiopathic scoliosis (AIS) and to compare this with normal anatomy.
There is an ongoing debate about the existence and magnitude of the vertebral body and pedicle asymmetry in AIS and whether this is an expression of a primary growth disturbance, or secondary to asymmetrical loading.
Vertebral body asymmetry, defined as left-right overlap of the vertebral endplates (ie, 100%: perfect symmetry, 0%: complete asymmetry) was evaluated in the true transverse plane on CT scans of 77 AIS patients and 32 non-scoliotic controls. Additionally, the pedicle width, length, and angle and the length of the ideal screw trajectory were calculated.
Scoliotic vertebrae were on average more asymmetric than controls (thoracic: AIS 96.0% vs. controls 96.4%; p = .005, lumbar: 95.8% vs. 97.2%; p < .001) and more pronounced around the thoracic apex (95.8%) than at the end vertebrae (96.3%; p = .031). In the thoracic apex; the concave pedicle was thinner (4.5 vs. 5.4 mm; p < .001) and longer (20.9 vs. 17.9 mm; p < .001), the length of the ideal screw trajectory was longer (43.0 vs. 37.3 mm; p < .001), and the transverse pedicle angle was greater (12.3° vs. 5.7°; p < .001) than the convex one. The axial rotation showed no clear correlation with the asymmetry.
Even in non-scoliotic controls is a degree of vertebral body and pedicle asymmetry, but scoliotic vertebrae showed slightly more asymmetry, mostly around the thoracic apex. In contrast to the existing literature, there is no major asymmetry in the true transverse plane in AIS and no uniform relation between the axial rotation and vertebral asymmetry could be observed in these moderate to severe patients, suggesting that asymmetrical vertebral growth does not initiate rotation, but rather follows it as a secondary phenomenon.
Level 4.
横断面研究。
量化青少年特发性脊柱侧凸（AIS）患者在真正横断面上椎体和椎弓根的不对称性，并与正常解剖结构进行比较。
关于AIS中椎体和椎弓根不对称的存在及程度，以及这是原发性生长紊乱的表现还是由不对称负荷继发引起，一直存在争议。
在77例AIS患者和32例非脊柱侧凸对照者的CT扫描图像上，于真正横断面上评估椎体不对称性，其定义为椎体终板的左右重叠情况（即100%：完全对称，0%：完全不对称）。此外，计算椎弓根的宽度、长度、角度以及理想螺钉置入轨迹的长度。
脊柱侧凸椎体平均比对照者更不对称（胸椎：AIS为96.0%，对照者为96.4%；p = 0.005；腰椎：95.8% 对97.2%；p < 0.001），且在胸段顶点周围更明显（95.8%），高于终椎（96.3%；p = 0.031）。在胸段顶点，凹侧椎弓根更薄（4.5对5.4 mm；p < 0.001）且更长（20.9对17.9 mm；p < 0.001），理想螺钉置入轨迹更长（43.0对37.3 mm；p < 0.001），椎弓根横角大于凸侧（12.3°对5.7°；p < 0.001）。轴向旋转与不对称性无明显相关性。
即使在非脊柱侧凸对照者中也存在一定程度的椎体和椎弓根不对称，但脊柱侧凸椎体的不对称性略高，主要在胸段顶点周围。与现有文献不同，在AIS患者的真正横断面上没有明显的不对称，并且在这些中度至重度患者中未观察到轴向旋转与椎体不对称之间存在统一关系，这表明不对称椎体生长并非引发旋转，而是作为一种继发现象伴随旋转出现。
4级。
