Children's Orthopaedics and Scoliosis Surgery Associates, Saint Petersburg, FL, USA.
University of South Florida Orthopaedics, Tampa, FL, USA.
Eur Spine J. 2019 Jun;28(6):1349-1355. doi: 10.1007/s00586-019-05960-z. Epub 2019 Apr 12.
Determining whether to fuse a Lenke 5 curve to L3 or to L4 is often a difficult decision. The purpose of this study was to determine preoperative variables predictive of an "ideal" or "less than ideal" outcome for Lenke 5 curves instrumented to L3.
A multicentre registry of adolescent idiopathic scoliosis patients was queried for surgically treated Lenke 5 curves with a lowest instrumented vertebra (LIV) of L3 and minimum 2 years of follow-up. Five seasoned surgeons qualitatively rated the 2-year postoperative images as "ideal" or "less than ideal" with respect to correction and alignment. Preoperative and postoperative radiographic variables were compared between the two groups. Multivariate regression analysis was performed to determine variables most predictive of a "less than ideal" outcome.
One hundred and thirty-nine patients met criteria. Twenty-three were considered "less than ideal" by ≥ 3 surgeons; 81 were unanimously "ideal". Preoperatively, the "less than ideal" group had significantly stiffer curves, greater apical translation, and greater LIV angulation and translation. Multivariate regression found that preoperative L3 translation (p = 0.009) was the single most important predictor of a "less than ideal" outcome: < 3.5 cm consistently resulted in an "ideal" outcome, while > 3.5 cm risked a "less than ideal" result.
While multiple variables are important in achieving an "ideal" outcome in Lenke 5 curves, this study found preoperative L3 translation was the most important predictor of success with an L3 translation < 3.5 cm being a potential threshold for selecting L3 as the LIV. These slides can be retrieved under Electronic Supplementary Material.
确定是否融合 Lenke 5 型曲线至 L3 或 L4 通常是一个困难的决策。本研究旨在确定术前变量，以预测 Lenke 5 型曲线在器械固定至 L3 时的“理想”或“不理想”结果。
对接受手术治疗的青少年特发性脊柱侧凸患者的多中心登记处进行了查询，这些患者的最低器械固定椎（LIV）为 L3，且至少有 2 年的随访。5 位经验丰富的外科医生根据术后 2 年的图像对“理想”或“不理想”的矫正和对线进行了定性评估。比较了两组患者的术前和术后影像学变量。进行多变量回归分析，以确定对“不理想”结果最具预测性的变量。
符合标准的患者有 139 名。23 名患者至少有 3 位外科医生认为“不理想”；81 名患者被一致认为“理想”。术前，“不理想”组的曲线僵硬程度显著更高，顶椎偏移更大，LIV 角度和移位更大。多变量回归发现，术前 L3 移位（p=0.009）是“不理想”结果的唯一最重要预测因素：<3.5cm 始终导致“理想”结果，而>3.5cm 则存在“不理想”结果的风险。
虽然在实现 Lenke 5 型曲线的“理想”结果时，多个变量都很重要，但本研究发现术前 L3 移位是成功的最重要预测因素，L3 移位<3.5cm 可能是选择 L3 作为 LIV 的一个潜在阈值。这些幻灯片可在电子补充材料中检索。
