Ishikawa Masayuki, Nishiyama Makoto, Kamata Michihiro
Department of Orthopaedic Surgery, Keiyu Hospital, Kanagawa, Japan.
Spine and Spinal Cord Center, Mita Hospital, International University of Health and Welfare, Tokyo, Japan.
Spine Surg Relat Res. 2018 Oct 10;3(2):113-125. doi: 10.22603/ssrr.2018-0047. eCollection 2019 Apr 27.
Controversies still exist in the surgical indications and outcomes of selective thoracic fusion (STF) for a primary thoracic curve with a compensatory large lumbar curve (King-Moe type II/Lenke 1C curve) in adolescent idiopathic scoliosis (AIS). Issues of the greatest concern regarding this curve type include curve criteria that indicate STF to prevent postoperative coronal decompensation and postoperative radiographic outcomes, including curve correction, coronal balance, and thoracolumbar kyphosis, after STF.
This review comprehensively documents the issues raised in the literature regarding surgical indications and radiographic outcomes of STF for King-Moe type II/Lenke 1C curve in AIS.
Studies suggest that radiographic curve criteria indicating STF for this curve type include the preoperative dominance of the thoracic curve to the lumbar curve in the Cobb angle and the characteristics of the lumbar curve in magnitude and flexibility. Studies warn the need for a careful clinical evaluation of the thoracic and lumbar rotational prominences. Documented radiographic outcomes of importance include the postoperative behavior of the unfused lumbar curve, coronal or sagittal decompensation after STF, and factors associated with these issues. A comprehensive review of the literature suggests that the use of a segmental pedicle screw construct and better instrumented thoracic curve correction achieve better spontaneous lumbar curve correction. Although the causes of postoperative coronal decompensation remain multifactorial, preoperative coronal decompensation to the left and an inappropriate selection of the lowest instrumented vertebra are consistently reported to be the major causative factors.
STF has been validated in general for the treatment of King-Moe type II or Lenke 1C curve in AIS; however, controversies remain regarding the surgical indications and outcomes. Long-term impacts of residual lumbar curve, coronal decompensation, and mild thoracolumbar kyphosis on clinical outcomes after STF, along with optimal indications and strategy for STF, should further be assessed.
对于青少年特发性脊柱侧凸（AIS）中具有代偿性大腰椎弯（King-Moe II型/Lenke 1C型曲线）的原发性胸弯，选择性胸椎融合术（STF）的手术指征和结果仍存在争议。关于这种曲线类型最受关注的问题包括表明STF可预防术后冠状面失代偿的曲线标准，以及STF术后的影像学结果，包括曲线矫正、冠状面平衡和胸腰段后凸。
本综述全面记录了文献中提出的关于AIS中King-Moe II型/Lenke 1C型曲线的STF手术指征和影像学结果的问题。
研究表明，表明该曲线类型适合STF的影像学曲线标准包括术前Cobb角中胸弯对腰弯的优势以及腰弯在大小和柔韧性方面的特征。研究警告需要对胸腰段旋转突出进行仔细的临床评估。记录的重要影像学结果包括未融合腰弯的术后表现、STF后的冠状面或矢状面失代偿以及与这些问题相关的因素。对文献的全面综述表明，使用节段性椎弓根螺钉结构和更好的胸椎曲线矫正器械可实现更好的腰弯自发矫正。尽管术后冠状面失代偿的原因仍然是多因素的，但术前向左冠状面失代偿和最低融合椎体选择不当一直被报道为主要致病因素。
STF总体上已被验证可用于治疗AIS中的King-Moe II型或Lenke 1C型曲线；然而，关于手术指征和结果仍存在争议。STF术后残留腰弯、冠状面失代偿和轻度胸腰段后凸对临床结果的长期影响，以及STF的最佳指征和策略，应进一步评估。
