Department of Orthopedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China.
Department of Orthopedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China.
Spine J. 2019 May;19(5):803-815. doi: 10.1016/j.spinee.2018.11.006. Epub 2018 Nov 15.
An anteroposterior combined approach has been used for the treatment of congenital cervical or cervicothoracic scoliosis. However, its outcomes and surgical risks have not been clarified.
We analyzed the characteristics of congenital cervical and cervicothoracic scoliosis and evaluated the outcomes of an anteroposterior combined approach for its treatment.
We carried out a retrospective clinical study of prospectively collected data.
Sixteen patients were treated between 2009 and 2013. Their average age was 9.2years.
Radiographic and surgical outcomes were measured and recorded. We compared morphological parameters and preoperative and postoperative results.
All patients underwent surgery with a combined approach. The following radiographic parameters were measured: head tilt (HT), mandible incline (MI), shoulder balance (SB), structural and compensatory curves, cervical lordosis, C7 central sacral vertical line (C7-CSVL) ratio, C7 sagittal vertical axis (C7-SVA) ratio, C2-C7 SVA ratio, the angle between the upper endplate of the T2 vertebra and a horizontal line (T2 tilt), gravity line ratio. Demographic and surgical data were also collected.
On average, the duration of follow-up was 68.0 months, surgical blood loss was 675mL, and the duration of surgery was 400.5 minutes. The average correction rate was 64.9% in the structural curve and 29.5% in the compensatory curve. Statistical analysis showed that MI significantly correlated with HT and SB (p<.05). The C7-CSVL ratio correlated with the HT, MI, and SB (p<.05). The C7-SVA ratio correlated with the structural curve and cervical lordosis (p<.05), and the gravity line ratio correlated with the structural and compensatory curve, cervical lordosis, and C7-SVA ratio (p<.05). Moreover, there were correlations between the structural and compensatory curves as well as between the structural curve and cervical lordosis (p<.05). There were significant differences before and after surgery in HT, MI, and structural and compensatory curves. Four patients developed nerve root palsy after surgical correction and totally recovered by 6 months of follow-up.
The combined approach is an effective surgical option for congenital cervical or cervicothoracic scoliosis. The resection of the hemivertebra cannot only improve head-neck aesthetic appearance but can also maintain the growth potential of the neck.
对于先天性颈椎或颈胸段脊柱侧凸，已经采用前后联合入路进行治疗。然而，其结果和手术风险尚未明确。
我们分析了先天性颈椎和颈胸段脊柱侧凸的特点，并评估了前后联合入路治疗该病的效果。
我们对前瞻性收集的数据进行了回顾性临床研究。
2009 年至 2013 年期间共 16 例患者接受了治疗。他们的平均年龄为 9.2 岁。
测量和记录影像学和手术结果。我们比较了形态参数以及术前和术后结果。
所有患者均采用联合入路进行手术。测量了以下影像学参数：头倾斜（head tilt，HT）、下颌倾斜（mandible incline，MI）、肩部平衡（shoulder balance，SB）、结构性和代偿性曲线、颈椎前凸角、C7 椎体中心矢状位垂直距离（C7-Central Sacral Vertical Line，C7-CSVL）比值、C7 矢状垂直轴（C7-Sagittal Vertical Axis，C7-SVA）比值、C2-C7 矢状垂直轴比值、T2 椎体上终板与水平线之间的夹角（T2 tilt）、重力线比值。收集了人口统计学和手术数据。
平均随访时间为 68.0 个月，手术失血量为 675ml，手术时间为 400.5 分钟。结构性曲度的平均矫正率为 64.9%，代偿性曲度的平均矫正率为 29.5%。统计分析显示，MI 与 HT 和 SB 显著相关（p<.05）。C7-CSVL 比值与 HT、MI 和 SB 相关（p<.05）。C7-SVA 比值与结构性曲线和颈椎前凸角相关（p<.05），重力线比值与结构性和代偿性曲线、颈椎前凸角和 C7-SVA 比值相关（p<.05）。此外，结构性和代偿性曲线之间以及结构性曲线与颈椎前凸角之间均存在相关性（p<.05）。HT、MI 和结构性及代偿性曲线在术前和术后均有显著差异。4 例患者在手术后矫正时出现神经根麻痹，随访 6 个月后完全恢复。
对于先天性颈椎或颈胸段脊柱侧凸，前后联合入路是一种有效的手术选择。半椎体切除不仅可以改善头颈部的美观，还可以维持颈部的生长潜力。
