ElBromboly Yehia, Hurry Jennifer, Padhye Kedar, Johnston Charles, McClung Anna, Samdani Amer, Glotzbecker Michael, Attia Abdallah, St Hilaire Tricia, El-Hawary Ron
Zagazig University, Shaibet an Nakareyah, Markaz El-Zakazik, Ash Sharqia Governorate 44519, Egypt.
IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8, Canada.
Spine Deform. 2019 Sep;7(5):822-828. doi: 10.1016/j.jspd.2019.02.001.
Retrospective, comparative.
To determine if distraction-based surgeries will increase spine length in patients with nonidiopathic EOS and whether etiology affects final spine length.
As early-onset scoliosis (EOS) has many etiologies, it is unclear whether etiology affects the spine length achieved with distraction-based surgeries. Since distraction may produce kyphosis, sagittal spine length (SSL; curved arc length of the spine in the sagittal plane) should be utilized.
Patients with nonidiopathic EOS treated with distraction-based systems (minimum 5-year follow-up, 5 lengthenings) were identified from two EOS registries. Radiographic analysis preoperation, postimplant (L1), and after each lengthening (L2-L5, L6-L10, L11-L15) was performed with primary outcome of T1-S1 SSL.
We identified 126 patients (67 congenital, 38 syndromic, 21 neuromuscular) with a mean preoperative age of 4.6 years, scoliosis 75°, kyphosis 48°, and a mean of 12 lengthenings. After initial correction (p < .05), scoliosis remained constant (58° at L11-L15) and kyphosis increased (38° at L1 to 60° at L11-L15) (p < .05). SSL increased for the entire group from 27.1 cm preoperation to 35.3 cm at L11-L15 (p < .05) and during the distraction phase (29.2 cm at L1 to 35.3 cm at L11-L15) (p < .05). Preoperative SSL was higher in neuromuscular compared with congenital patients and maintained that difference until the 10th lengthening. Preoperative SSL did not differ between syndromic and congenital patients (28.0 cm vs. 25.6 cm); however, syndromic patients had greater SSL after implantation (L1: 30.5 cm vs. 26.8 cm) (p < .05) and maintained that difference until the 15th lengthening (37.1 cm vs. 34.3 cm) (p < .05).
At minimum 5-year follow-up, distraction-based surgeries increased spine length for all patients with nonidiopathic EOS; however, neuromusculars had higher preoperative spine length compared with congenital patients and maintained that difference until the 10th lengthening. Although congenital and syndromic patients had similar preoperative spine length, syndromic patients had greater SSL after implantation (L1) and maintained that difference until the 15th lengthening.
Level III.
回顾性、比较性研究。
确定基于撑开的手术是否会增加非特发性早发性脊柱侧凸（EOS）患者的脊柱长度，以及病因是否会影响最终的脊柱长度。
由于早发性脊柱侧凸（EOS）有多种病因，目前尚不清楚病因是否会影响基于撑开的手术所达到的脊柱长度。由于撑开可能会导致后凸畸形，因此应采用矢状面脊柱长度（SSL；脊柱在矢状面的弯曲弧长）。
从两个EOS登记处识别出接受基于撑开系统治疗的非特发性EOS患者（至少随访5年，进行5次延长）。在术前、植入后（L1）以及每次延长后（L2-L5、L6-L10、L11-L15）进行影像学分析，主要观察指标为T1-S1 SSL。
我们识别出126例患者（67例先天性、38例综合征性、21例神经肌肉性），术前平均年龄为4.6岁，脊柱侧凸75°，后凸48°，平均延长12次。初始矫正后（p < .05），脊柱侧凸保持稳定（L11-L15时为58°），而后凸增加（L1时为38°至L11-L15时为60°）（p < .05）。整个组的SSL从术前的27.1 cm增加到L11-L15时的35.3 cm（p < .05），在撑开阶段也有增加（L1时为29.2 cm至L11-L15时为35.3 cm）（p < .05）。与先天性患者相比，神经肌肉性患者术前的SSL更高，并在第10次延长前一直保持这种差异。综合征性和先天性患者术前的SSL无差异（28.0 cm对25.6 cm）；然而，综合征性患者植入后（L1）的SSL更大（30.5 cm对26.8 cm）（p < .05），并在第15次延长前一直保持这种差异（37.1 cm对34.3 cm）（p < .05）。
至少随访5年时，基于撑开的手术增加了所有非特发性EOS患者的脊柱长度；然而，与先天性患者相比，神经肌肉性患者术前的脊柱长度更高，并在第10次延长前一直保持这种差异。虽然先天性和综合征性患者术前的脊柱长度相似，但综合征性患者植入后（L1）的SSL更大，并在第15次延长前一直保持这种差异。
三级。
