Skaggs David L, Seehausen Derek A, Yamaguchi Kent T, Hah Raymond J, Wright Margaret L, Bumpass David B, Kim Han J, Andras Lindsay M, Vitale Michael G, Lenke Lawrence G
Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA.
Division of Pediatric Orthopaedic Surgery, Columbia University Medical Center, 630 West 168th St., New York, NY, 10032, USA.
Spine Deform. 2016 Mar;4(2):125-130. doi: 10.1016/j.jspd.2015.08.006. Epub 2016 Dec 30.
Multicenter, retrospective cohort study.
The purpose of this study is to determine how the amount of residual lowest instrumented vertebra (LIV) tilt correlates with radiographic measurements. When performing a selective thoracic posterior spinal fusion for adolescent idiopathic scoliosis (AIS), the LIV may be tilted into the lumbar curve or made horizontal.
This is a multicenter retrospective study of 33 consecutive patients with AIS, Lenke types 1 to 4, lumbar modifier C, and a minimum follow-up of 2 years, who underwent selective thoracic posterior spinal fusions. Measurements obtained from pre- and postoperative radiographs were correlated with postoperative LIV tilt.
At final follow-up, less postoperative LIV tilt significantly correlated with less thoracic apical translation (p =.023) when controlling for the position of the LIV relative to the stable vertebra and preoperative thoracic and lumbar curve flexibility. LIV tilt was not significantly associated with thoracic Cobb angle, lumbar Cobb angle, lumbar apical translation, coronal balance, sagittal balance, or the amount of correction obtained compared to their preoperative measurements (p >.05).
Decreased LIV tilt was significantly associated with decreased thoracic apical translation. LIV tilt did not significantly correlate with coronal balance or any other radiographic measurement. We caution that these findings may only be applicable in C modifier curves and when the correct LIV is chosen.
Level III, Therapeutic study.
多中心回顾性队列研究。
本研究旨在确定最低融合椎（LIV）残余倾斜量与影像学测量值之间的相关性。在对青少年特发性脊柱侧凸（AIS）进行选择性胸段后路脊柱融合术时，LIV可能会向腰段曲线倾斜或变为水平。
这是一项对33例连续的AIS患者进行的多中心回顾性研究，患者Lenke分型为1至4型，腰椎修正型为C型，且至少随访2年，均接受了选择性胸段后路脊柱融合术。术前和术后X线片的测量结果与术后LIV倾斜情况相关。
在末次随访时，在控制LIV相对于稳定椎体的位置以及术前胸段和腰段曲线柔韧性的情况下，术后LIV倾斜度越小与胸段顶椎平移越小显著相关（p = 0.023）。与术前测量值相比，LIV倾斜与胸段Cobb角、腰段Cobb角、腰段顶椎平移、冠状面平衡、矢状面平衡或矫正量均无显著相关性（p > 0.05）。
LIV倾斜度降低与胸段顶椎平移减少显著相关。LIV倾斜与冠状面平衡或任何其他影像学测量值均无显著相关性。我们提醒，这些发现可能仅适用于C修正型曲线以及选择正确LIV的情况。
III级，治疗性研究。
