Bachmann Keith R, Yaszay Burt, Bartley Carrie E, Bastrom Tracey P, Reighard Fredrick G, Upasani Vidyadhar V, Newton Peter O
Department of Orthopedics, University of Virginia Medical Center, Charlottesville, VA, USA.
Department of Orthopedics, Rady Children's Hospital, 3030 Children's Way, MC5062, San Diego, CA, 92123, USA.
Childs Nerv Syst. 2019 Sep;35(9):1585-1590. doi: 10.1007/s00381-019-04239-4. Epub 2019 Jun 10.
To evaluate the three-dimensional (3D) characteristics of spine deformity in patients with non-idiopathic scoliosis compared with those observed in patients with adolescent idiopathic scoliosis (AIS).
A retrospective chart review was conducted to identify patients with non-idiopathic scoliosis. Twenty-eight patients with neural axis (NA) abnormalities (Chiari 1, syrinx) and 20 patients with connective tissue disorder (CTD) (Marfan's, Beal's, Ehlers-Danlos syndrome, mixed) were identified. The 3D parameters of the coronal, sagittal, and axial plane were compared with 284 AIS patients with a similar range of coronal deformity.
The average coronal curve was similar between all three groups (AIS 48 ± 15°, CTD 43 ± 22°, and NA 49 ± 18°; p = 0.4). The NA patients had significantly greater 3D thoracic kyphosis (20 ± 18° vs 10 ± 15°, p = 0.001) and less thoracic apical vertebral rotation (- 5 ± 18° vs - 12 ± 10°, p = 0.003) when compared with AIS. The CTD group's 3D thoracic kyphosis (p = 0.7) and apical vertebral rotation (p = 0.09) did not significantly differ from AIS. Significant negative correlations were found in all three groups between thoracic kyphosis and coronal curve magnitude (AIS r = - 0.49, CTD r = - 0.772, NA r = -0.677, all p < 0.001).
Scoliotic patients with NA abnormalities have a more kyphotic, less-rotated 3D profile than patients with AIS, while scoliosis patients with CTD have 3D features similar to AIS. Irrespective of the underlying diagnosis, however, greater scoliotic curves were associated with a greater loss of intersegmental kyphosis, suggesting a similar biomechanical pathophysiology for curve progression.
评估非特发性脊柱侧弯患者脊柱畸形的三维（3D）特征，并与青少年特发性脊柱侧弯（AIS）患者的特征进行比较。
进行一项回顾性病历审查以确定非特发性脊柱侧弯患者。识别出28例患有神经轴（NA）异常（Chiari 1型、脊髓空洞症）的患者和20例患有结缔组织疾病（CTD）（马凡氏综合征、Beal综合征、埃勒斯-当洛综合征、混合型）的患者。将冠状面、矢状面和轴面的3D参数与284例冠状面畸形范围相似的AIS患者进行比较。
所有三组患者的平均冠状面曲线相似（AIS 48±15°，CTD 43±22°，NA 49±18°；p = 0.4）。与AIS患者相比，NA患者的3D胸椎后凸明显更大（20±18°对10±15°，p = 0.001），胸椎顶椎旋转更小（-5±18°对-12±10°，p = 0.003）。CTD组的3D胸椎后凸（p = 0.7）和顶椎旋转（p = 0.09）与AIS患者相比无显著差异。在所有三组中，胸椎后凸与冠状面曲线大小之间均存在显著负相关（AIS r = -0.49，CTD r = -0.772，NA r = -0.677，均p < 0.001）。
与AIS患者相比，患有NA异常的脊柱侧弯患者具有更后凸、旋转更少的3D形态，而患有CTD的脊柱侧弯患者具有与AIS相似的3D特征。然而，无论潜在诊断如何，更大的脊柱侧弯曲线与节段间后凸的更大丧失相关，提示曲线进展存在相似的生物力学病理生理学。
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