Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
Biomed Res Int. 2018 Mar 29;2018:3247010. doi: 10.1155/2018/3247010. eCollection 2018.
To investigate the natural history of distal adding-on in adolescent idiopathic scoliosis (AIS) and to identify risk factors for its progression.
Sixty-one AIS patients with distal adding-on occurrence were included. We further classify distal adding-on into progressive and nonprogressive group according to its natural evolution. The first radiograph indicating initiation of adding-on (primary adding-on) and the last follow-up radiograph were compared in terms of the deviation of the first vertebra below instrumentation from the CSVL and the angulation of the first disc below instrumentation. Compared to primary adding-on, progressive adding-on was defined as a further increase of deviation > 5 mm or a further increase of angulation > 5°. Risk factors associated with the progression of adding-on were analyzed.
Among 61 patients diagnosed with distal adding-on, 24 (39.3%) were progressive and 37 (60.7%) were nonprogressive. Lower Risser grade, open triradiate cartilage, and lowest instrumented vertebra (LIV) proximal to Substantially Stable Vertebra (SSV) were found to be significantly associated with the progressive adding-on. Besides, the distal adding-on was more likely to progress for patients with higher left shoulders than right ones after surgery.
The risk factors for the progression of adding-on included skeletal immaturity, LIV proximal to SSV, and higher left shoulders after surgery.
研究青少年特发性脊柱侧凸（AIS）中远端附加的自然史，并确定其进展的危险因素。
纳入 61 例 AIS 患者出现远端附加。根据其自然演变，我们进一步将远端附加分为进展性和非进展性组。比较首次出现附加的第一张 X 光片（原发性附加）和最后一次随访的 X 光片，比较器械以下第一椎体偏离 CSVL 和器械以下第一椎间盘的角度。与原发性附加相比，进展性附加定义为进一步增加的偏离 >5mm 或进一步增加的角度 >5°。分析与附加进展相关的危险因素。
在诊断为远端附加的 61 例患者中，24 例（39.3%）为进展性，37 例（60.7%）为非进展性。较低的 Risser 分级、开放三辐射软骨和最低的器械化椎体（LIV）靠近基本稳定的椎体（SSV）与进展性附加显著相关。此外，术后左肩高于右肩的患者远端附加更有可能进展。
进展性附加的危险因素包括骨骼不成熟、SSV 近端的 LIV 和术后左肩较高。
