Akgül Turgut, Sarıyılmaz Kerim, Korkmaz Murat, Özkunt Okan, Kaya Özcan, Dikici Fatih
Department of Orthopaedics and Traumatology, İstanbul Faculty of Medicine, İstanbul University, Istanbul, Turkey.
Acıbadem University, Atakent Hospital, Istanbul, Turkey.
Asian Spine J. 2018 Feb;12(1):147-155. doi: 10.4184/asj.2018.12.1.147. Epub 2018 Feb 7.
Retrospective analysis of adolescent idiopathic scoliosis.
This study aimed to investigate the influence of distinct distal fusion levels on spinopelvic parameters in patients with adolescent idiopathic scoliosis (AIS) who underwent posterior instrumentation and fusion surgery.
The distal fusion level selection in treatment of AIS is the one of milestone to effect on surgical outcome. Most of the paper focused on the coronal deformity correction and balance. The literature have lack of knowledge about spinopelvic changing after surgical treatment and the relation with distal fusion level. We evaluate the spinopelvic and pelvic parameter alteration after fusion surgery in treatment of AIS.
A total of 100 patients with AIS (88 females and 12 males) were retrospectively reviewed. Patients were assigned into the following three groups according to the distal fusion level: lumbar 2 (L2), lumbar 3 (L3), and lumbar 4 (L4). Using a lateral plane radiograph of the whole spine, spinopelvic angular parameters such as thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were radiologically assessed.
The mean age was 15±2.4 years, and the mean follow-up period was 24.27±11.69 months. Regarding the lowest instrumented vertebra, patients were categorized as follows: 30 patients in L2 (group 1), 40 patients in L3 (group 2), and 30 patients in L4 (group 3). TK decreased from 36.60±13.30 degrees preoperatively to 26.00±7.3 degrees postoperatively in each group (=0.001). LL decreased from 52.8±9.4 degrees preoperatively to 44.30±7.50 degrees postoperatively (=0.001). Although PI showed no difference preoperatively among the groups, it was statistically higher postoperatively in group 3 than in the other groups (<0.05). In addition, in group 2, PI decreased from 50.60±8.74 degrees preoperatively to 48.00±6.84 degrees postoperatively (=0.027). SS decreased from 35.20±6.40 degrees preoperatively to 33.40±5.80 degrees postoperatively (=0.08, >0.05). However, mean SS was significantly higher in group 3 (=0.042, <0.05). PT decreased from 15.50±7.90 degrees preoperatively to 15.2±7.10 degrees postoperatively. The positive relationship (28.5%) between LL and PI measurements was statistically significant (=0.285; =0.004, <0.01). Furthermore, the positive relationship (36.5%) between LL and SS measurements was statistically significant (=0.365; =0.001, <0.01).
When the distal instrumentation level in AIS surgery is below L3, a significant change in PT and SS (pelvic parameters) is anticipated.
青少年特发性脊柱侧凸的回顾性分析。
本研究旨在调查不同的远端融合水平对接受后路器械固定和融合手术的青少年特发性脊柱侧凸（AIS）患者脊柱骨盆参数的影响。
AIS治疗中远端融合水平的选择是影响手术效果的关键因素之一。大多数文献聚焦于冠状面畸形矫正和平衡。目前对于手术治疗后脊柱骨盆的变化以及与远端融合水平的关系了解不足。我们评估了AIS融合手术后脊柱骨盆和骨盆参数的改变。
回顾性分析100例AIS患者（88例女性，12例男性）。根据远端融合水平将患者分为以下三组：腰2（L2）、腰3（L3）和腰4（L4）。使用全脊柱侧位X线片，对胸椎后凸（TK）、腰椎前凸（LL）、骨盆入射角（PI）、骶骨倾斜角（SS）和骨盆倾斜角（PT）等脊柱骨盆角度参数进行影像学评估。
平均年龄为15±2.4岁，平均随访时间为24.27±11.69个月。关于最低固定椎体，患者分类如下：L2组30例（第1组），L3组40例（第2组），L4组30例（第3组）。每组中，TK从术前的36.60±13.30度降至术后的26.00±7.3度（=0.001）。LL从术前的52.8±9.4度降至术后的44.30±7.50度（=0.001）。虽然术前各组间PI无差异，但术后第3组的PI在统计学上高于其他组（<0.05）。此外，在第2组中，PI从术前的50.60±8.74度降至术后的48.00±6.84度（=0.027）。SS从术前的35.20±6.40度降至术后的33.40±5.80度（=0.08，>0.05）。然而，第3组的平均SS显著更高（=0.042，<0.05）。PT从术前的15.50±7.90度降至术后的15.2±7.10度。LL与PI测量值之间的正相关关系（28.5%）具有统计学意义（=0.285；=0.004，<0.01）。此外，LL与SS测量值之间的正相关关系（36.5%）具有统计学意义（=0.365；=0.001，<0.01）。
当AIS手术的远端器械固定水平低于L3时，预计PT和SS（骨盆参数）会有显著变化。
