Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.
Spine (Phila Pa 1976). 2018 May 1;43(9):654-660. doi: 10.1097/BRS.0000000000002383.
A retrospective study.
To determine the incidence and risk factors of coronal decompensation after posterior-only thoracolumbar hemivertebra (HV) resection and short fusion in patients younger than 5-years old.
Postoperative coronal decompensation may occur in operated patients during the follow up. However, there is a paucity of valid data regarding this complication in very young patients with thoracolumbar HV.
This study reviewed a consecutive series of patients (younger than 5 years) who had undergone posterior-only hemivertebrectomy and short fusion from January 2006 to December 2014. They had a minimum follow-up of 24 months. According to the coronal compensation behavior, they were divided into two groups: Group P (progressed, curve decompensated beyond twenty degrees) and Group NP (nonprogressed, curve well compensated).
There were 179 patients included in this study. Mean age at surgery was 38 ± 11 months. Mean follow-up was 41 ± 11 months. Postoperative coronal decompensation was identified in 18 patients (rate, 10.1%) who constituted Group P. The remaining 161 patients had a well-compensated pattern. In contrast to Group NP, the patients in Group P had greater preoperative lowest instrumented vertebra (LIV) translation (18.5 mm ± 6.4 mm vs. 10.5 mm ± 4.9 mm, P < 0.01), and higher postoperative LIV disc angle (7.0° ± 3.1° vs. 3.1° ± 3.3°, P < 0.01) after surgery. During the follow up, LIV translation and LIV disc experienced continuous aggravation until initiation of bracing. Preoperative LIV translation (≥15.1 mm) and postoperative LIV disc angle (≥5.5°) were identified as two independent risk factors of coronal decompensation after surgery.
After thoracolumbar hemivertebrectomy in children younger than 5 years, the overall rate of coronal decompensation is approximately 10.1%. As two independent risk factors of postoperative coronal decompensation, preoperative LIV translation (≥15.1 mm) and postoperative LIV disc angle (≥5.5°) should on all accounts be the major causes for concern.
回顾性研究。
确定年龄小于 5 岁的患者行单纯后路胸腰椎半椎体切除短节段融合术后冠状面失代偿的发生率及危险因素。
术后冠状面失代偿可能发生在接受手术的患者随访过程中。然而，对于年龄较小的胸腰椎半椎体患者，有关该并发症的有效数据仍然较少。
本研究回顾了 2006 年 1 月至 2014 年 12 月期间接受单纯后路半椎体切除术和短节段融合术的连续系列患者（年龄小于 5 岁）。他们的随访时间至少为 24 个月。根据冠状面代偿情况，将其分为两组：进展组（P 组，曲线代偿超过 20 度）和非进展组（NP 组，曲线代偿良好）。
本研究共纳入 179 例患者。手术时平均年龄为 38±11 个月。平均随访时间为 41±11 个月。18 例（10.1%）患者术后出现冠状面失代偿，构成 P 组。其余 161 例患者曲线代偿良好。与 NP 组相比，P 组患者术前最低固定椎体（LIV）位移更大（18.5mm±6.4mm 比 10.5mm±4.9mm，P<0.01），术后 LIV 椎间盘角度更高（7.0°±3.1°比 3.1°±3.3°，P<0.01）。在随访过程中，LIV 位移和 LIV 椎间盘持续加重，直至开始支具治疗。术前 LIV 位移（≥15.1mm）和术后 LIV 椎间盘角度（≥5.5°）是术后冠状面失代偿的两个独立危险因素。
在 5 岁以下儿童行胸腰椎半椎体切除术后，冠状面失代偿的总体发生率约为 10.1%。术前 LIV 位移（≥15.1mm）和术后 LIV 椎间盘角度（≥5.5°）是术后冠状面失代偿的两个独立危险因素，应引起高度重视。
4 级。
