Sánchez-Márquez Jose Miguel, Pizones Javier, Martín-Buitrago Mar Pérez, Fernández-Baillo Nicomedes, Pérez-Grueso Francisco Javier
Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain.
Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain.
Spine Deform. 2019 Mar;7(2):267-274. doi: 10.1016/j.jspd.2018.07.008.
Retrospective case series with comparative analysis.
To analyze a consecutive cohort of very young patients operated for congenital scoliosis secondary to a single hemivertebra (HV) and compare thoracolumbar (TL) versus lumbosacral (LS) curve results.
Despite the published successful results regarding early hemivertebra resection and short fusion for congenital hemivertebrae, literature lacks midterm results, especially in very young children.
Patients under 5 years of age, operated by HV resection and transpedicular short fusion, with follow-up longer than 5 years, were included. Preoperative, postoperative (1-year), final radiographic parameters, and complications were recorded. Midterm results were analyzed and TL versus LS curves were compared.
Twenty-three patients were included (14 TL and 9 LS HV). The mean age was 3.5 ± 1.7 years and the mean follow-up was 7.6 years (4.7-13.7). The mean preoperative Cobb angle (40.3° ± 6.7°), corrected 65% postoperatively and 50% at final follow-up. The compensatory cranial curve improved spontaneously from 25.3° ± 14.8° to 13.5° ± 12° and finally to 19.9° ± 10.7°. Preoperative coronal balance corrected postoperatively but worsened at the final follow-up. TL curves corrected more initially than LS curves (TL: -29°, 68%, vs. LS: -22°, 59%; p = .043); however, both groups lost correction at the final follow-up (TL: 4°, 56%, vs. LS: 7°, 39%; p = .186). The LS group had a larger preoperative compensatory curve, which corrected with surgery but lost more correction at the final follow-up (p = .046). Segmental kyphosis was especially corrected in the TL group (TL: -14° vs. LS: -2°, p = .018) and was maintained over time.
Early hemivertebra resection and transpedicular short fusion allowed good coronal correction initially, which was difficult to maintain at midterm, especially at the LS junction. Sagittal plane correction was excellent in TL deformities and was maintained over time. Results were more challenging in the LS group compared with TL deformities. Guidance to avoid unwanted results is proposed.
Level III.
采用比较分析的回顾性病例系列研究。
分析一组因单一半椎体（HV）导致先天性脊柱侧弯而接受手术的极低龄患者，并比较胸腰段（TL）与腰骶段（LS）弯曲的治疗结果。
尽管已有关于早期半椎体切除术和先天性半椎体短节段融合术取得成功结果的报道，但缺乏中期结果，尤其是在极低龄儿童中的结果。
纳入年龄小于5岁、接受HV切除和经椎弓根短节段融合术且随访时间超过5年的患者。记录术前、术后（1年）、最终影像学参数及并发症。分析中期结果并比较TL与LS弯曲情况。
纳入23例患者（14例TL型HV和9例LS型HV）。平均年龄为3.5±1.7岁，平均随访时间为7.6年（4.7 - 13.7年）。术前平均Cobb角为（40.3°±6.7°），术后矫正65%，最终随访时矫正50%。代偿性颈椎弯曲自发地从25.3°±14.8°改善至13.5°±12°，最终至19.9°±10.7°。术前冠状面平衡术后得到矫正，但在最终随访时恶化。TL弯曲最初比LS弯曲矫正更多（TL：-29°，68%；LS：-22°，59%；p = 0.043）；然而，两组在最终随访时均丢失了部分矫正（TL：4°，56%；LS：7°，39%；p = 0.186）。LS组术前代偿性弯曲更大，手术矫正后在最终随访时丢失更多矫正（p = 0.046）。TL组节段性后凸尤其得到矫正（TL：-14° vs LS：-2°，p = 0.018）且随时间维持。
早期半椎体切除和经椎弓根短节段融合术最初能实现良好的冠状面矫正，但中期难以维持，尤其是在腰骶交界处。矢状面矫正对于TL畸形效果极佳且随时间维持。与TL畸形相比，LS组的结果更具挑战性。提出避免不良结果的指导建议。
三级。
