Yasuda Tatsuya, Hasegawa Tomohiko, Yamato Yu, Togawa Daisuke, Kobayashi Sho, Yoshida Go, Banno Tomohiro, Arima Hideyuki, Oe Shin, Matsuyama Yukihiro
Department of Orthodedic Surgery, Hamamatsu Medical Center, Hamamatsu, Japan.
Department of Orthodedic Surgery, Hamamatsu University of Medicine, Hamamatsu, Japan.
Spine Surg Relat Res. 2018 Apr 7;2(4):283-289. doi: 10.22603/ssrr.2017-0081. eCollection 2018 Oct 26.
Correction of lumbar lordosis is the primary goal of surgical treatment of adult spinal deformity. However, only limited research has evaluated the effects of this correction on the adaptive curvature of the thoracic spine. The purpose of this study is to evaluate the change in thoracic curvature after corrective surgery to restore lumbar lordosis in patients with adult spinal deformity.
We completed a retrospective analysis of the radiological data of 65 patients, ≥50 years old, who underwent corrective surgery of lumbar spine lordosis from any level below T8 to the ilium. Patients with insufficient correction, defined by a pelvic incidence minus lumbar lordosis angle (PI-LL) > 10°, were excluded, with the data of 43 patients included in the analysis. The following radiological measures of spinal alignment were measured at three time points, preoperatively, on the first day of standing postoperatively and at 2 years post-surgery: sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), and PI-LL.
Postoperative change in TK was correlated to preoperative TK and age. The increase in TK was larger for patients <75 years of age, increasing from 23.1° to 38.0° after surgery and to 46.7° at 2-years postoperatively. In contrast, for patients >75 years, TK remained largely unchanged at 37.8° just after surgery but increased substantively to 50.1° at the 2-year follow-up. The postoperative change in TK immediately after surgery was determined using equation "predict change in TK = -0.21 × age - 0.6 × preoperative TK + 41.8" by multiple regression analysis.
Reciprocal change in TK after lumbar spine correction is correlated to preoperative TK and age.
纠正腰椎前凸是成人脊柱畸形外科治疗的主要目标。然而，仅有有限的研究评估了这种矫正对胸椎适应性曲度的影响。本研究的目的是评估成人脊柱畸形患者在进行恢复腰椎前凸的矫正手术后胸椎曲度的变化。
我们对65例年龄≥50岁、接受从T8以下任何节段至髂骨的腰椎前凸矫正手术的患者的放射学数据进行了回顾性分析。矫正不足（定义为骨盆入射角减去腰椎前凸角（PI-LL）>10°）的患者被排除，43例患者的数据纳入分析。在术前、术后站立第一天和术后2年这三个时间点测量以下脊柱排列的放射学指标：矢状垂直轴（SVA）、腰椎前凸（LL）、胸椎后凸（TK）、骨盆倾斜（PT）和PI-LL。
TK的术后变化与术前TK和年龄相关。年龄<75岁的患者TK增加幅度更大，术后从23.1°增加到38.0°，术后2年增加到46.7°。相比之下，年龄>75岁的患者术后TK在术后即刻基本保持在37.8°不变，但在2年随访时大幅增加到50.1°。通过多元回归分析，使用方程“预测TK变化=-0.21×年龄-0.6×术前TK+41.8”确定术后即刻TK的变化。
腰椎矫正术后TK的相互变化与术前TK和年龄相关。
