Chan C Y W, Kwan M K
Department of Orthopaedic Surgery, Faculty of Medicine, NOCERAL, University Malaya, 50603, Kuala Lumpur, Malaysia.
Eur Spine J. 2018 Feb;27(2):340-349. doi: 10.1007/s00586-017-5350-x. Epub 2017 Oct 20.
To evaluate the zonal differences in risk and pattern of pedicle screw perforations in adolescent idiopathic scoliosis (AIS) patients.
The scoliosis curves were divided into eight zones. CT scans were used to assess perforations: Grade 0, Grade 1(< 2 mm), Grade 2(2-4 mm) and Grade 3(> 4 mm). Anterior perforations were classified into Grade 0, Grade 1(< 4 mm), Grade 2(4-6 mm) and Grade 3(> 6 mm). Grade 2 and 3 (except lateral grade 2 and 3 perforation over thoracic vertebrae) were considered as 'critical perforations'.
1986 screws in 137 patients were analyzed. The overall perforation rate was 8.4% after exclusion of the lateral perforation. The highest medial perforation rate was at the transitional proximal thoracic (PT)/main thoracic (MT) zone (6.9%), followed by concave lumbar (6.7%) and convex main thoracic (MT) zone (6.1%). The overall critical medial perforation rate was 0.9%. 33.3% occurred at convex MT and 22.2% occurred at transitional PT/MT zone. There were 39 anterior perforations (overall perforation rate of 2.0%). 43.6% occurred at transitional PT/MT zone, whereas 23.1% occurred at concave PT zone. The overall critical anterior perforation rate was 0.6%. 5/12 (41.7%) critical perforations occurred at concave PT zone, whereas four perforations occurred at the transitional PT/MT zone. There were only two symptomatic left medial grade 2 perforations (0.1%) resulting radiculopathy, occurring at the transitional main thoracic (MT)/Lumbar (L) zone.
Overall pedicle perforation rate was 8.4%. Highest rate of critical medial perforation was at the convex MT zone and the transitional PT/MT zone, whereas highest rate of critical anterior perforation was at the concave PT zone and the transitional PT/MT zone. The rate of symptomatic perforations was 0.1%.
评估青少年特发性脊柱侧凸（AIS）患者椎弓根螺钉穿孔的风险及模式的节段差异。
将脊柱侧凸曲线分为八个节段。采用CT扫描评估穿孔情况：0级、1级（<2mm）、2级（2 - 4mm）和3级（>4mm）。前方穿孔分为0级、1级（<4mm）、2级（4 - 6mm）和3级（>6mm）。2级和3级（胸椎节段外侧2级和3级穿孔除外）被视为“严重穿孔”。
分析了137例患者的1986枚螺钉。排除外侧穿孔后，总体穿孔率为8.4%。内侧穿孔率最高的是在近端胸椎（PT）/主胸段（MT）过渡节段（6.9%），其次是凹侧腰椎（6.7%）和凸侧主胸段（MT）节段（6.1%）。总体严重内侧穿孔率为0.9%。33.3%发生在凸侧MT节段，22.2%发生在PT/MT过渡节段。有39例前方穿孔（总体穿孔率为2.0%）。43.6%发生在PT/MT过渡节段，而23.1%发生在凹侧PT节段。总体严重前方穿孔率为0.6%。12例严重穿孔中有5例（41.7%）发生在凹侧PT节段，4例发生在PT/MT过渡节段。仅有2例有症状的左侧内侧2级穿孔（0.1%）导致神经根病，发生在主胸段（MT）/腰椎（L）过渡节段。
总体椎弓根穿孔率为8.4%。严重内侧穿孔率最高的是在凸侧MT节段和PT/MT过渡节段，而严重前方穿孔率最高的是在凹侧PT节段和PT/MT过渡节段。有症状穿孔率为0.1%。
