Lonstein John E
Twin Cities Spine Center, 913 E 26th Street, Suite 600, Minneapolis, MN 55404, USA; Gillette Children's Specialty Healthcare, 200 University Ave E, St Paul, MN 55101, USA.
Spine Deform. 2018 Nov-Dec;6(6):669-675. doi: 10.1016/j.jspd.2018.04.008.
Selective thoracic fusions (STFs) were introduced by Moe to treat the structural thoracic curve when a more flexible lumbar component existed. It is unknown how the curves behave and how the patients function beyond 20 years after surgery.
Of the 152 eligible patients with STF, 67 were traced and contacted and 40 completed outcome questionnaires (Oswestry Disability index [ODI], Scoliosis Research Society-30 [SRS-30]) and had follow-up standing radiographs. The preoperative, postoperative, 1-year, and follow-up films were compared, and the lumbar spine on follow-up assessed for signs of degeneration-disc space narrowing, osteophyte formation, rotatory subluxation, and lateral spondylolisthesis.
The average follow-up was 32.7 years. There were 27 Lenke 1C, 10 Lenke 2C, and 3 Lenke 1B curves. A posterior fusion was performed in 37, with a Harrington rod used in 28 and all-hook constructs in 12 with fusion to T10 (1), T11 (10), T12 (22), or L1 (7). The average preoperative right thoracic curves were 56.1°, 36.2° 1 year postoperation, and 38.6° at follow-up. The average preoperative lumbar curve was 44.6°, being 35.2° at 1 year postoperation, and 36.9° at follow-up. Five patients had additional surgery, 3 pseudarthrosis repairs (one with extension of the fusion to L4), 1 implant removal, and 1 microdiscectomy 35 years postoperatively. At follow-up, the average ODI was 8.7 (0-62) and the average SRS-30 3.8 (1.4-4.9). Nine patients took nonnarcotic medication, usually weekly or less, with only one taking daily narcotics. The most common lumbar radiographic finding was disc space narrowing at the apex of the lumbar curve, and osteophytes at L2-L3. There was no correlation of the lumbar changes to ODI, with a tendency to more medication use with longer follow-up (older subjects).
At an average 33-year follow-up, the lumbar curve in STF is unchanged, with patients functioning well and mild radiographic changes in the lumbar spine.
莫伊引入选择性胸椎融合术（STF）来治疗存在更灵活腰椎节段的结构性胸椎侧弯。目前尚不清楚术后20多年后，侧弯的发展情况以及患者的功能状况。
在152例符合条件的STF患者中，67例被追踪并取得联系，40例完成了结局问卷（Oswestry功能障碍指数[ODI]、脊柱侧弯研究学会-30[SRS-30]）并进行了随访站立位X线片检查。比较术前、术后、术后1年及随访时的X线片，并评估随访时腰椎是否有退变迹象——椎间盘间隙变窄、骨赘形成、旋转性半脱位和侧方椎体滑脱。
平均随访32.7年。有27例Lenke 1C型、10例Lenke 2C型和3例Lenke 1B型侧弯。37例行后路融合术，其中28例使用哈灵顿棒，12例使用全钩装置，融合至T10（1例）、T11（10例）、T12（22例）或L1（7例）。术前平均右侧胸椎侧弯角度为56.1°，术后1年为36.2°，随访时为38.6°。术前平均腰椎侧弯角度为44.6°，术后1年为35.2°，随访时为36.9°。5例患者接受了二次手术，3例为假关节修复（1例融合范围扩展至L4），1例取出植入物，1例在术后35年进行了显微椎间盘切除术。随访时，平均ODI为8.7（0 - 62），平均SRS-30为3.8（1.4 - 4.9）。9例患者服用非麻醉性药物，通常每周或更少次数，只有1例每日服用麻醉性药物。腰椎X线最常见的表现是腰椎侧弯顶点处的椎间盘间隙变窄以及L2 - L3处有骨赘形成。腰椎变化与ODI无相关性，且随访时间越长（患者年龄越大）使用药物的倾向越高。
平均33年的随访结果显示，STF术后腰椎侧弯无变化，患者功能良好，腰椎有轻微的影像学改变。
