Sullivan T Barrett, Bastrom Tracey P, Bartley Carrie E, Shah Suken A, Lonner Baron S, Asghar Jahangir, Miyanji Firoz, Newton Peter O, Yaszay Burt
University of California, San Diego, CA, USA.
Rady Children's Hospital, 3030 Children's Way, Suite 410, San Diego, CA, 92123, USA.
Eur Spine J. 2018 Feb;27(2):312-318. doi: 10.1007/s00586-017-5158-8. Epub 2017 Jun 10.
Previous research has shown that with certain idiopathic scoliosis curve types, performing a selective thoracic fusion (STF) is associated with an increased risk of coronal decompensation post-operatively. The purpose of the current study was to determine the influence of curve correction and fusion level on post-operative balance in STF for adolescent idiopathic scoliosis patients with pre-operative coronal decompensation.
A multicenter database was queried for subjects with right Lenke 1-4C curves, pre-operative left coronal imbalance, and 2-year follow-up who underwent STF (caudal fusion level of L1 or proximal). Rates of decompensation were compared between groups with different levels of fusion. Thoracic and lumbar curve correction as well as Scoliosis Research Society-22 outcome scores were compared between groups that were post-operatively balanced or persistently decompensated.
121 patients were identified with average thoracic and lumbar curves of 53° and 41°. Mean pre- and post-operative decompensations were 2.4 ± 1.0 and 1.8 ± 1.1 cm, respectively. Eighteen patients were fused short, 62 to, and 41 were fused past the stable vertebra. Ten patients were fused short, 32 to, and 78 were fused past the neutral vertebra. Incidence of post-operative decompensation was 41%. No differences in post-operative decompensation relative to the stable or neutral vertebra were noted (p = 0.66, p = 0.74). Post-operatively, those patients who were balanced had similar thoracic curve correction (58%) to those decompensated (54%, p = 0.11); however, patients balanced post-operatively had greater SLCC (45 vs 40%, p = 0.04). No differences in SRS-22 outcome scores were noted between groups (p > 0.05).
There was a high rate of post-operative decompensation in patients with pre-operative coronal decompensation undergoing STF. Fusion to or past the stable or neutral vertebra did not affect the risk of persistent decompensation. Attempts to improve SLCC could reduce post-operative decompensation.
先前的研究表明，对于某些特发性脊柱侧凸曲线类型，进行选择性胸椎融合术（STF）与术后冠状面失代偿风险增加相关。本研究的目的是确定在接受STF治疗的术前存在冠状面失代偿的青少年特发性脊柱侧凸患者中，曲线矫正和融合节段对术后平衡的影响。
查询多中心数据库，纳入患有右侧Lenke 1-4C曲线、术前左侧冠状面失衡且接受STF（融合尾端节段为L1或更靠近头端）并随访2年的患者。比较不同融合节段组之间的失代偿率。比较术后平衡或持续失代偿组之间的胸段和腰段曲线矫正以及脊柱侧凸研究学会-22（Scoliosis Research Society-22，SRS-22）结局评分。
共纳入121例患者，平均胸段和腰段曲线分别为53°和41°。术前和术后平均失代偿分别为2.4±1.0和1.8±1.1 cm。18例患者融合节段较短，62例融合至，41例融合超过稳定椎体。10例患者融合节段较短，32例融合至，78例融合超过中立椎体。术后失代偿发生率为41%。未观察到相对于稳定或中立椎体的术后失代偿差异（p = 0.66，p = 0.74）。术后，平衡的患者与失代偿的患者胸段曲线矫正相似（分别为58%和54%，p = 0.11）；然而，术后平衡的患者有更高的矢状面 Cobb 角矫正（45%对40%，p = 0.04）。两组之间SRS-22结局评分无差异（p>0.05）。
术前存在冠状面失代偿的患者接受STF术后失代偿率较高。融合至或超过稳定或中立椎体并不影响持续失代偿风险。尝试改善矢状面Cobb角矫正可降低术后失代偿。
