Uehara Masashi, Takahashi Jun, Ikegami Shota, Kuraishi Shugo, Futatsugi Toshimasa, Oba Hiroki, Takizawa Takashi, Munakata Ryo, Koseki Michihiko, Kato Hiroyuki
Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto City, Nagano, Japan.
Clin Spine Surg. 2019 Aug;32(7):E326-E329. doi: 10.1097/BSD.0000000000000794.
This is a retrospective single-center and single-surgeon study.
We investigated the correlation between lower instrumented vertebra (LIV) and spinal mobility 2 years after posterior spinal fusion with pedicle screws for adolescent idiopathic scoliosis (AIS) for optimal LIV selection.
Spinal motion can become limited in scoliosis patients who undergo posterior spinal fusion. However, few reports exist on spinal mobility after posterior spinal fusion for AIS and the relationship between the LIV and mobility is unknown. We hypothesize that mobility limitation increases as the LIV is moved inferiorly.
Of 72 consecutive patients who received posterior spinal fusion using pedicle screws for AIS between October 2009 and August 2015, 66 patients (5 male and 61 female, mean age: 14.9 y) were enrolled.
In total, 66 patients were retrospectively reviewed after stratification according to LIV level. Follow-up rate was 91.7%. Patients were examined for the fingertip-to-floor distance (FFD) before and 2 years after surgery. FFD was measured from the tips of the middle fingers to the floor with the barefoot subject bent maximally forward and the feet together and knees straight. Clinical outcome was assessed using Scoliosis Research Society-22 patient questionnaire (SRS-22r) scores and a visual analog scale for low back pain before and at 2 years postoperatively.
The median number of fused vertebrae was 9 (range: 4-15). The LIV was T11-12 in 15 patients, L1 in 11 patients, L2 in 10 patients, and L3 in 30 patients. The median decrease in FFD according to LIV at 2 years after surgery was T11-12: 0 cm, L1: 0 cm, L2: 5.5 cm, and L3: 10 cm. Thus, limited FFD became significantly more severe as the LIV was moved downwards (P<0.01). There were no significant correlations between limited FFD and SRS-22r or pain visual analog scale scores at 2 years postoperatively.
FFD became significantly more restricted as the LIV was moved inferiorly but clinical results appeared unaffected by limited FFD.
这是一项回顾性单中心、单术者研究。
我们研究了青少年特发性脊柱侧凸（AIS）患者后路椎弓根螺钉脊柱融合术后2年时，下固定椎（LIV）与脊柱活动度之间的相关性，以优化LIV的选择。
接受后路脊柱融合术的脊柱侧凸患者的脊柱活动可能会受限。然而，关于AIS患者后路脊柱融合术后脊柱活动度以及LIV与活动度之间关系的报道很少。我们假设随着LIV向下移动，活动度受限会增加。
在2009年10月至2015年8月期间连续72例接受AIS后路椎弓根螺钉脊柱融合术的患者中，纳入了66例患者（5例男性和61例女性，平均年龄：14.9岁）。
根据LIV水平分层后，对66例患者进行回顾性分析。随访率为91.7%。在术前和术后2年检查患者的指尖至地面距离（FFD）。FFD是在受试者赤足、最大限度向前弯腰、双脚并拢且膝盖伸直的情况下，从中指指尖测量至地面的距离。使用脊柱侧凸研究学会22项患者问卷（SRS-22r）评分和术后2年时的下腰痛视觉模拟量表评估临床结局。
融合椎体的中位数为9个（范围：4 - 15个）。15例患者的LIV为T11 - 12，11例患者为L1，10例患者为L2，30例患者为L3。术后2年时，根据LIV的FFD中位数下降情况为：T11 - 12：0厘米，L1：0厘米，L2：5.5厘米，L3：10厘米。因此，随着LIV向下移动，FFD受限变得明显更严重（P < 0.01）。术后2年时，FFD受限与SRS-22r或疼痛视觉模拟量表评分之间无显著相关性。
随着LIV向下移动，FFD受限明显更严重，但临床结果似乎不受FFD受限的影响。
