Zhang Zhen, Liu Zhen, Zhu Zezhang, Qiu Yong
Department of Spine Surgery, Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
Medicine (Baltimore). 2017 Dec;96(49):e8799. doi: 10.1097/MD.0000000000008799.
This is a retrospective study. The aim of this study was to access sagittal compensatory mechanism of the cervical spine in thoracic adolescent idiopathic scoliosis (T-AIS) before and after posterior spinal fusion and to identify preoperative or immediate postoperative radiographic parameters that can predict the ultimate cervical sagittal alignment (CSA) after long-term follow-up.A retrospective study was performed on 44 T-AIS patients treated with posterior spinal fusion and with at least 5 years of follow-up. Preoperative, immediate postoperative and latest follow-up radiographs were reviewed measuring cervical lordosis (CL), cervical sagittal vertical axis (CSVA), upper thoracic kyphosis (UTK), main thoracic kyphosis (MTK), global thoracic kyphosis (GTK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Pearson correlation analysis, stepwise multilinear regression analysis, and receiver operator characteristic (ROC) curve were performed to define the relationship between ultimate CL and preoperative or immediate postoperative radiographic parameters.CL significantly improved from 6.6 ± 8.8 degree kyphosis preoperatively to 3.8 ± 8.7 degree kyphosis immediate postoperatively and to 0.5 ± 7.3 degree lordosis at the latest follow-up. Pre- and postoperative CSVA showed no significant difference. Pearson correlation coefficient test showed that CL was only correlated to T1 slope and UTK before surgery, whereas it was correlated to T1 slope, UTK, and GTK after surgery. The following equation was developed to estimate the ultimate CL: ultimate CL = -2.792 + 0.510 × Preop CL + 0.531 × Postop T1 slope. Furthermore, ROC curve showed that preoperative CL ≥-4.5 degree was strongly predictive and postoperative T1 slope ≥11.3 degree was moderately predictive of lordotic cervical spine after long-term follow-up.For T-AIS patients, CL significantly increased after surgery with the restoration of the global and regional sagittal profile. The sagittal compensatory mechanism of the cervical spine before surgery is different from that after surgery. In these patients, preoperative CL and immediate postoperative T1 slope could be predictors of the ultimate CSA after long-term follow-up.
这是一项回顾性研究。本研究的目的是评估青少年胸椎特发性脊柱侧凸（T-AIS）患者后路脊柱融合术前、术后颈椎矢状面的代偿机制，并确定术前或术后即刻的影像学参数，以预测长期随访后的最终颈椎矢状面排列（CSA）。对44例行后路脊柱融合术且至少随访5年的T-AIS患者进行了回顾性研究。回顾术前、术后即刻及最新随访的X线片，测量颈椎前凸（CL）、颈椎矢状垂直轴（CSVA）、上胸椎后凸（UTK）、主胸椎后凸（MTK）、全胸椎后凸（GTK）、腰椎前凸（LL）、骨盆倾斜度（PI）、骨盆倾斜角（PT）和骶骨坡度（SS）。进行Pearson相关性分析、逐步多元线性回归分析和受试者工作特征（ROC）曲线分析，以确定最终CL与术前或术后即刻影像学参数之间的关系。CL从术前6.6±8.8°的后凸显著改善为术后即刻3.8±8.7°的后凸，并在最新随访时变为0.5±7.3°的前凸。术前和术后CSVA无显著差异。Pearson相关系数检验显示，术前CL仅与T1斜率和UTK相关，而术后与T1斜率、UTK和GTK相关。建立了以下方程来估计最终CL：最终CL = -2.792 + 0.510×术前CL + 0.531×术后T1斜率。此外，ROC曲线显示，术前CL≥-4.5°对长期随访后颈椎前凸具有强预测性，术后T1斜率≥11.3°具有中度预测性。对于T-AIS患者，术后CL显著增加，整体和局部矢状面形态得以恢复。颈椎术前和术后的矢状面代偿机制不同。在这些患者中，术前CL和术后即刻T1斜率可作为长期随访后最终CSA的预测指标。
