Harris Liam, Andras Lindsay M, Mundis Gregory M, Sponseller Paul D, Emans John B, Skaggs David L
Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
San Diego Center for Spinal Disorders, San Diego, CA, USA.
Spine Deform. 2020 Aug;8(4):781-786. doi: 10.1007/s43390-020-00064-x. Epub 2020 Mar 3.
Retrospective multi-center enrollment.
To examine the impact of patient and surgical factors on proximal complication and revision rates of early onset scoliosis patients using a multicenter database. Proximal anchor pullout and junctional kyphosis are common causes necessitating revision surgery during growth friendly treatment of early onset scoliosis (EOS). Many options exist for proximal fixation and may impact the rate of these complications.
Retrospective review of multicenter database of patients with growth friendly constructs for EOS. Inclusion criteria were patients with index instrumentation < 10 years of age and minimum of 2 year follow-up.
353 patients met the inclusion criteria and had the following constructs: growing rods with spine anchors = 303; growing rods with rib anchors = 15 and VEPTR = 35. Mean age at index instrumentation was 6.0 years. Mean preoperative Cobb angle was 76° and mean kyphosis was 54°. Mean follow-up was 6.0 years. 21.8% of patients (77/353) experienced anchor pullout. Lower anchor pullout rates were associated with a higher numbers of proximal anchors (p = 0.003, r = - 0.157), and 5 or more anchors were associated with lower rates of anchor pullout (p = 0.014). Anchor type (rib hooks vs spine anchors vs rib cradle) did not impact rate of anchor pullout (p = 0.853). Kyphosis data was available for 198 patients. 23.2% (46/198) of these patients required proximal extension of their construct after index surgery. Initial instrumentation below the upper end vertebrae (UEV) of kyphosis was associated with higher rates of subsequent proximal revision; 28.9% (20/69) compared to 20.1% (26/129) for those instrumented at or above the UEV (p = 0.035). Preoperative kyphosis and change in thoracic kyphosis were not associated with anchor pullout (p = 0.436, p = 0.115) or proximal revision rates (p = 0.486, p = 0.401).
Five or more anchors are associated with lower rates of anchor pullout. Proximal anchor placement at or above the UEV resulted in a significant decrease in rates of proximal extension of the construct.
回顾性多中心入组研究。
利用多中心数据库研究患者因素和手术因素对早发性脊柱侧凸患者近端并发症及翻修率的影响。在早发性脊柱侧凸（EOS）的生长友好型治疗中，近端锚钉拔出和交界性后凸是需要翻修手术的常见原因。近端固定有多种选择，可能会影响这些并发症的发生率。
回顾性分析EOS生长友好型内固定患者的多中心数据库。纳入标准为初次手术时年龄＜10岁且随访至少2年的患者。
353例患者符合纳入标准，采用了以下内固定方式：带脊柱锚钉的生长棒=303例；带肋骨锚钉的生长棒=15例；垂直可扩张钛肋骨假体（VEPTR）=35例。初次手术时的平均年龄为6.0岁。术前平均Cobb角为76°，平均后凸为54°。平均随访时间为6.0年。21.8%的患者（77/353）发生了锚钉拔出。较低的锚钉拔出率与更多的近端锚钉数量相关（p = 0.003，r = -0.157），5个或更多锚钉与较低的锚钉拔出率相关（p = 0.014）。锚钉类型（肋骨钩与脊柱锚钉与肋骨支架）不影响锚钉拔出率（p = 0.853）。198例患者有后凸数据。其中23.2%（46/198）的患者在初次手术后需要对其内固定进行近端延长。在驼背的上端椎体（UEV）下方进行初次内固定与随后更高的近端翻修率相关；在UEV处或上方进行内固定的患者为20.1%（26/129），而在UEV下方进行内固定的患者为28.9%（20/69）（p = 0.035）。术前驼背和胸段驼背的变化与锚钉拔出（p = 0.436，p = 0.115）或近端翻修率（p = 0.486，p = 0.401）无关。
5个或更多锚钉与较低的锚钉拔出率相关。在UEV处或上方放置近端锚钉可显著降低内固定近端延长的发生率。
