Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA.
Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA.
World Neurosurg. 2020 Feb;134:e37-e45. doi: 10.1016/j.wneu.2019.08.123. Epub 2019 Aug 28.
Despite advancements in surgical techniques, controversy remains regarding the optimal implant density for the correction of idiopathic scoliosis. Recent evidence has suggested that equivalent radiographic and clinical outcomes can be achieved with lower implant densities for those with moderate curves and good flexibility. Among the experts, the consensus has continued that higher implant densities should be used for larger, stiffer curves. The purpose of the present study was to compare the radiographic results between high-implant density (HID) and low-implant density (LID) constructs in patients with large (>65°), rigid (<50% flexibility) curves who had undergone anterior release and posterior spinal fusion.
We reviewed the idiopathic scoliosis cases performed at a single institution from 2006 to 2014. Only those meeting the inclusion criteria were selected. The patients were divided into HID and LID groups. The postoperative radiographs were compared for coronal correction, thoracic kyphosis, pelvic tilt, lumbar lordosis, and sagittal vertical axis.
A statistically significant improvement in coronal correction was detected in the HID group at all follow-up points (final follow-up: HID, 81.1% vs. LID, 70.4%; P = 0.01). When preoperative thoracic kyphosis was considered, no differences were found between the 2 groups. No differences were found in the other sagittal parameters.
In patients with large, rigid idiopathic scoliosis undergoing anterior release and posterior spinal fusion, a small, but statistically, significant improvement in the coronal Cobb angle was seen. It remains to be determined whether this small difference in radiographic correction will have any influence on the clinical outcome.
尽管手术技术不断进步，但对于特发性脊柱侧凸的最佳植入物密度仍存在争议。最近的证据表明，对于中度曲线和良好柔韧性的患者，较低的植入物密度可以实现等效的影像学和临床结果。在专家中，共识仍然是对于更大、更僵硬的曲线应使用更高的植入物密度。本研究的目的是比较在接受前路松解和后路脊柱融合的大（>65°）、僵硬（<50%柔韧性）曲线患者中，高植入密度（HID）和低植入密度（LID）结构的影像学结果。
我们回顾了 2006 年至 2014 年在一家机构进行的特发性脊柱侧凸病例。仅选择符合纳入标准的患者。患者分为 HID 和 LID 组。比较术后 X 线片的冠状矫正、胸椎后凸、骨盆倾斜、腰椎前凸和矢状垂直轴。
在所有随访点，HID 组的冠状矫正均有统计学显著改善（最终随访：HID 组 81.1%，LID 组 70.4%；P=0.01）。当考虑术前胸椎后凸时，两组之间没有差异。其他矢状参数无差异。
在接受前路松解和后路脊柱融合的大、僵硬的特发性脊柱侧凸患者中，冠状 Cobb 角有较小但有统计学意义的改善。尚不确定这种影像学矫正的微小差异是否会对临床结果产生任何影响。
