Patel Ashish, Oh Jason, Leven Dante, Cautela Frank S, Chatterjee Dipal, Naziri Qais, Langella Francesco, Diebo Bassel G, Paulino Carl B
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, New York.
Orthopedic Division, Second University of Naples, Naples, Italy.
Int J Spine Surg. 2018 Mar 30;12(1):8-14. doi: 10.14444/5002. eCollection 2018 Jan.
We investigated impact of vertebral axial rotation on neurovascular anatomy in adult spinal deformity (ASD) patients and provided recommendations on the approach based on degree of axial rotation. In order to isolate vertebral rotation (VR) impact from the superimposed degenerative cascade observed in adulthood, adolescent idiopathic scoliosis (AIS) patients were analyzed.
Magnetic resonance imaging (MRI) scans (L1-S1) from 50 right-convex thoracic (left-convex lumbar) AIS patients were analyzed. At each intervertebral level, VR, lumbar plexus depth (LPD), and vascular structure depth (VSD) were evaluated. Paired test analyses were used to describe anatomic differences between the concave and convex aspect of our patients' curves. Correlation analysis was used to investigate relationships with soft tissue modifications and VR.
Fifty AIS patients (17M, 33F) with mean thoracic Cobb of 50.6° ± 17.0° and mean lumbar Cobb of 41.9° ± 13.0° were included. Mean VR at each level was L1-2 = -6.6°, L2-3 = -7.7°, L3-4 = -6.5°, L4-5 = -4.7°, L5-S1 = -2.6° (negative value denotes clockwise rotation). We found significant differences ( < .05) between concave-convex (right-left) LPD at each level (L1-2 = 3.7 mm, L2-3 = 5.1 mm, L3-4 = 4.2 mm, L4-5 = 2.2 mm, L5-S1 = 2.2 mm). Vascular structure depth was significantly different at L1-L2 (3.2 mm) and L5-S1 (3 mm). Significant correlation was found between increasing VR and concave-convex LPD difference ( = 0.68, < .001).
This study demonstrates that displacement of the lumbar plexus is tied to the magnitude of VR in patients with AIS. When approaching the lumbar spine, this displacement widens the safe surgical corridor on the convex side and narrows the corridor on the concave side.
IV.
Preoperative review of MRI scans should occur to assess the patient's safe surgical corridor for lateral lumbar interbody fusion (LLIF). Adult spinal deformity surgeons who approach a degenerated spine in patients with progressive AIS in adulthood must carefully plan for patient positioning, neurovascular anatomy, and realignment objectives prior to the day of surgical intervention.
我们研究了椎体轴向旋转对成人脊柱畸形（ASD）患者神经血管解剖结构的影响，并根据轴向旋转程度给出了手术入路建议。为了将椎体旋转（VR）的影响与成年期观察到的叠加性退变过程区分开来，我们分析了青少年特发性脊柱侧凸（AIS）患者。
分析了50例右凸胸段（左凸腰段）AIS患者的磁共振成像（MRI）扫描（L1-S1）。在每个椎间水平，评估VR、腰丛深度（LPD）和血管结构深度（VSD）。采用配对t检验分析来描述患者侧弯凹侧和凸侧之间的解剖差异。采用相关性分析来研究与软组织改变和VR之间的关系。
纳入50例AIS患者（17例男性，33例女性），平均胸段Cobb角为50.6°±17.0°，平均腰段Cobb角为41.9°±13.0°。每个水平的平均VR为：L1-2=-6.6°，L2-3=-7.7°，L3-4=-6.5°，L4-5=-4.7°，L5-S1=-2.6°（负值表示顺时针旋转）。我们发现每个水平凹侧与凸侧（右-左）LPD之间存在显著差异（P<0.05）（L1-2=3.7mm，L2-3=5.1mm，L3-4=4.2mm，L4-5=2.2mm，L5-S1=2.2mm）。血管结构深度在L1-L2（3.2mm）和L5-S1（3mm）处有显著差异。VR增加与凹侧-凸侧LPD差异之间存在显著相关性（r=0.68，P<0.001）。
本研究表明，AIS患者腰丛的移位与VR的大小相关。在处理腰椎时，这种移位使凸侧的安全手术通道变宽，凹侧的通道变窄。
IV级。
术前应复查MRI扫描，以评估患者进行腰椎侧方椎间融合术（LLIF）的安全手术通道。成年后对患有进展性AIS的患者进行退变脊柱手术的成人脊柱畸形外科医生，在手术干预当天之前必须仔细规划患者体位、神经血管解剖结构和矫正目标。
