Miyazaki Shingo, Suzuki Teppei, Yurube Takashi, Kakutani Kenichiro, Nishida Kotaro, Uno Koki
Department of Orthopaedic Surgery, National Hospital Organization, Kobe Medical Center, 3 Chome-1-1 Nishiochiai, Suma-ku, Kobe, 654-0155, Japan.
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 1-1, Rokkodai-cho, Nada-ku, Kobe, 657-8501, Japan.
Spine Deform. 2020 Apr;8(2):245-256. doi: 10.1007/s43390-019-00020-4. Epub 2020 Feb 5.
Retrospective case series.
To elucidate the postoperative course of sagittal alignment in patients with congenital thoracolumbar to lumbar kyphosis or kyphoscoliosis. Acquisition of acceptable sagittal alignment is essential to treat spinal deformity. Little evidence exists regarding long-term surgical outcomes on sagittal alignment in congenital kyphosis or kyphoscoliosis.
Sixteen consecutive patients (mean age 10.5 ± 3.5 years) with congenital kyphosis or kyphoscoliosis who underwent vertebra resection and osteotomy with instrumentation by single posterior or combined anterior and posterior approach were included. Preoperative radiographs identified kyphosis in 3 patients and kyphoscoliosis in 13 patients. All patients had clinical and radiologic follow-up for > 10 years (mean 16.3 ± 4.0 years).
Segmental kyphosis was significantly improved from 33.9° ± 20.1° to 14.9° ± 17.6° by surgery and was finally maintained at 16.8° ± 22.2° and sagittal vertical axis (SVA) of 13.1 ± 33.7 mm at preoperation and 18.3 ± 22.1 mm at postoperation significantly increased to 26.8 ± 45.7 mm during follow-up. Of the 16 patients, 5 (31%) were identified as those with SVA > 40 mm, and SVA increases > 30 mm during follow-up. In patients with sagittal malalignment, radiographs demonstrated decreased lumbar lordosis at the lower foundation from 28.8° ± 39.0° to 17.0° ± 17.6°, significant increased pelvic tilt from 25.8° ± 5.4° to 37.4° ± 7.4° during follow-up (p < 0.05), and larger residual segmental kyphosis than those in the 11 patients without sagittal malalignment with statistical significance. Of the five cases, progression of local kyphosis (one case) and sagittal decompensation, including decreased lumbar lordosis with disc degeneration (four cases), increased pelvic tilt (three cases), or proximal junctional kyphosis (two cases), were observed.
Based on this > 10-year follow-up study, residual kyphosis and sagittal decompensation are revealed to be risk factors for postoperative sagittal malalignment in patients with congenital thoracolumbar to lumbar kyphosis or kyphoscoliosis.
Level IV, case series.
回顾性病例系列。
阐明先天性胸腰段至腰段后凸畸形或脊柱侧凸患者矢状面排列的术后进程。获得可接受的矢状面排列对于治疗脊柱畸形至关重要。关于先天性后凸畸形或脊柱侧凸矢状面排列的长期手术结果，证据较少。
纳入16例连续的先天性后凸畸形或脊柱侧凸患者（平均年龄10.5±3.5岁），这些患者接受了经单一后路或前后联合入路的椎体切除、截骨及内固定术。术前X线片显示3例为后凸畸形，13例为脊柱侧凸。所有患者均进行了超过10年（平均16.3±4.0年）的临床和影像学随访。
手术使节段性后凸畸形从33.9°±20.1°显著改善至14.9°±17.6°，最终维持在16.8°±22.2°，矢状垂直轴（SVA）术前为13.1±33.7mm，术后为18.3±22.1mm，随访期间显著增加至26.8±45.7mm。16例患者中，5例（31%）被确定为SVA>40mm，且随访期间SVA增加>30mm。在矢状面排列不齐的患者中，X线片显示下基础节段的腰椎前凸从28.8°±39.0°降至17.0°±17.6°，随访期间骨盆倾斜度从25.8°±5.4°显著增加至37.4°±7.4°（p<0.05），且残留节段性后凸畸形比11例无矢状面排列不齐的患者更大，差异有统计学意义。在这5例患者中，观察到局部后凸畸形进展（1例）和矢状面失代偿，包括腰椎前凸降低伴椎间盘退变（4例）、骨盆倾斜增加（3例）或近端交界性后凸畸形（2例）。
基于这项超过10年的随访研究，残留后凸畸形和矢状面失代偿被揭示为先天性胸腰段至腰段后凸畸形或脊柱侧凸患者术后矢状面排列不齐的危险因素。
IV级，病例系列。
