Burks S Shelby, Uribe Juan S, Kolcun John Paul G, Fortunel Adisson, Godzik Jakub, Bach Konrad, Wang Michael Y
1Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and.
2Department of Neurological Surgery, The Barrow Neurological Institute, Phoenix, Arizona.
J Neurosurg Spine. 2019 Aug 16;31(6):851-856. doi: 10.3171/2019.5.SPINE19192. Print 2019 Dec 1.
Minimally invasive techniques are increasingly used in adult deformity surgery as surgeon familiarity improves and long-term data are published. Concerns raised in such cases include pseudarthrosis at levels where interbody grafts are not utilized. Few previous studies have specifically examined the thoracolumbar component of long surgical constructs, which is commonly instrumented without interbody or intertransverse fusion.
A retrospective analysis was performed on all patients who underwent hybrid minimally invasive deformity corrections in two academic spine centers over a 9-year period. Inclusion criteria were at least 2 rostral levels instrumented percutaneously, ranging from T8 to L1 as the upper end of the construct. Fusion assessment was made using CT when possible or radiography. Common radiographic parameters and clinical variables were assessed pre- and postoperatively.
A total of 36 patients fit the inclusion criteria. Baseline characteristics included a 1:1.8 male/female ratio, average age of 65.7 years, and BMI of 30.2 kg/m2. Follow-up imaging was obtained at a mean of 35.7 months. The average number of levels fused was 7.5, with an average of 3.4 instrumented percutaneously between T8 and L1, representing a total of 120 rostral levels instrumented percutaneously. Fusion assessment was performed using CT in 69 levels and radiography in 51 levels. Among the 120 rostral levels instrumented percutaneously, robust fusion was noted in 25 (20.8%), with 53 (44.2%) exhibiting some evidence of fusion. Pseudarthrosis was noted in 2 rostral segments (1.7%). There were no instances of proximal hardware revision. Eight patients exhibited radiographic proximal junctional kyphosis (PJK; 22.2%), none of whom underwent surgical intervention.
In the present series of adult patients with scoliosis undergoing thoracolumbar deformity correction, rostral segments instrumented percutaneously have a very low rate of pseudarthrosis, with radiographic evidence of bone fusion occurring in more than 60% of patients. The rate of PJK was acceptable and similar to other published series.
随着外科医生对微创技术的熟悉程度提高以及长期数据的公布，微创技术在成人脊柱畸形手术中的应用越来越广泛。此类病例中出现的问题包括未使用椎间融合器的节段发生假关节形成。此前很少有研究专门针对长节段手术固定结构的胸腰段部分进行研究，该节段通常采用经皮器械固定，未进行椎间或横突间融合。
对两个学术性脊柱中心在9年期间接受混合式微创脊柱畸形矫正手术的所有患者进行回顾性分析。纳入标准为每例患者至少有2个节段经皮器械固定，固定结构的上端范围为T8至L1。尽可能使用CT或X线片进行融合评估。术前和术后评估常见的影像学参数和临床变量。
共有36例患者符合纳入标准。基线特征包括男性与女性比例为1:1.8，平均年龄65.7岁，体重指数为30.2kg/m²。平均随访35.7个月。平均融合节段数为7.5个，T8至L1之间平均经皮器械固定3.4个节段，共120个节段经皮器械固定。69个节段采用CT进行融合评估，51个节段采用X线片评估。在120个经皮器械固定的头端节段中，25个（20.8%）显示牢固融合，53个（44.2%）有融合迹象。2个头端节段（1.7%）出现假关节形成。没有近端器械翻修的情况。8例患者出现影像学近端交界性后凸（PJK；22.2%），均未接受手术干预。
在本系列接受胸腰段脊柱畸形矫正的成年脊柱侧凸患者中，经皮器械固定的头端节段假关节形成率极低，超过60%的患者有骨融合的影像学证据。PJK发生率可接受，与其他已发表系列相似。
