Yamagata Toru, Chataigner Herve, Longis Pierre-Marie, Takami Toshihiro, Delecrin Joël
Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Orthopaedic Surgery, Nantes University Hospital, Nantes, France.
J Craniovertebr Junction Spine. 2019 Apr-Jun;10(2):100-107. doi: 10.4103/jcvjs.JCVJS_42_19.
The primary radiological goal of surgery for adult spinal deformity (ASD) is the restoration of lumbar lordosis (LL). Radiological parameters were analyzed to determine the surgical indications for ASD using posterior side-loading spinal instrumentation system.
This retrospective study included 31 patients of ASD who underwent posterior instrumented fusion surgery. Imaging parameters included spinal tilt angle (STA), LL, and thoracic kyphosis (TK). The ideal LL was estimated based on the normal value.
Of 16 patients with sagittal imbalance, 10 patients demonstrated sagittal balance postoperatively. All six patients with frontal imbalance showed frontal balance postoperatively. STA improvement well correlated with change of LL. On univariate analysis, preoperative TK was significantly associated with preoperative sagittal imbalance and postoperative lack of LL with postoperative sagittal imbalance.
The surgical concept of ASD focusing on correction of LL was demonstrated. Although the surgery of ASD is still challenging, posterior instrumented fusion surgery using posterior side-loading system may be well applied for mild or moderate ASD without hyper-TK. The posterior side-loading system is practical and can be one of the surgical choices.
成人脊柱畸形（ASD）手术的主要放射学目标是恢复腰椎前凸（LL）。分析放射学参数以确定使用后侧加载脊柱内固定系统治疗ASD的手术指征。
这项回顾性研究纳入了31例行后路器械融合手术的ASD患者。影像学参数包括脊柱倾斜角（STA）、LL和胸椎后凸（TK）。根据正常值估算理想的LL。
16例矢状面失衡患者中，10例术后实现了矢状面平衡。6例冠状面失衡患者术后均实现了冠状面平衡。STA的改善与LL的变化密切相关。单因素分析显示，术前TK与术前矢状面失衡以及术后矢状面失衡时LL未恢复显著相关。
证明了以矫正LL为重点的ASD手术理念。尽管ASD手术仍具有挑战性，但使用后侧加载系统的后路器械融合手术可能适用于无高TK的轻、中度ASD。后侧加载系统实用，可作为手术选择之一。
