Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
Eur Spine J. 2020 Aug;29(8):2054-2063. doi: 10.1007/s00586-020-06353-3. Epub 2020 Mar 4.
To investigate whether the rotation of preoperative-presumed lowest instrumented vertebra (LIV) is a risk factor for adding-on (AO) in adolescent idiopathic scoliosis (AIS) treated with selective posterior thoracic fusion (sPTF).
A total of 196 AIS patients of Lenke type 1A or 2A with minimum 2-year follow-up after sPTF with all pedicle screw instrumentation were included. Radiographical parameters were measured as follows: preoperative rotation angle of presumed LIV and LIV + 1, LIV + 1/LIV rotation difference, postoperative rotation angle of LIV and LIV derotation angle on CT scans. Patients were classified into AO group and non-AO group during the follow-up. The parameters were compared between the two groups to investigate risk factors for AO.
Among 196 patients, 40 (20.4%) patients developed with AO at the final follow-up. Compared with non-AO group, patients with AO had significantly larger preoperative rotation angle of presumed LIV (8.8° ± 3.4° vs. 3.4° ± 2.9°, P < 0.001) and LIV + 1 (5.9° ± 4.0° vs. 3.6° ± 2.9°, P = 0.004), LIV + 1/LIV rotation difference (- 2.6° ± 3.7° vs. 0.6° ± 3.2°, P < 0.001) and postoperative rotation angle of LIV (7.2° ± 4.3° vs. 3.0° ± 2.9°, P < 0.001). The last substantially touched vertebrae (LSTV) was selected as LIV in 148 patients, among which the above described parameters were found to be remarkably larger in AO group than non-AO group as well. Multivariate analysis presented Risser grade and preoperative rotation angle of presumed LIV as independent predictors of AO.
AIS patients with low Risser grade and large preoperative rotation angle of presumed LIV are more likely to develop with AO after sPTF. Moreover, for the patients with LSTV selected as LIV, preoperative rotation of presumed LIV might be still a risk factor associated with the occurrence of AO.
III These slides can be retrieved under Electronic Supplementary Material.
研究术前预设最低节段椎（LIV）旋转是否是选择性后路胸椎融合术（sPTF）治疗青少年特发性脊柱侧凸（AIS）中附加（AO）的危险因素。
共纳入 196 例 Lenke 1A 或 2A 型 AIS 患者，sPTF 后至少随访 2 年，所有患者均采用全椎弓根螺钉内固定。影像学参数如下：术前预设 LIV 和 LIV+1 的旋转角度、LIV+1/LIV 旋转差值、术后 LIV 的旋转角度和 CT 扫描上的 LIV 去旋转角度。在随访期间，将患者分为 AO 组和非 AO 组。比较两组间参数，以探讨发生 AO 的危险因素。
196 例患者中，40 例（20.4%）患者在最终随访时出现 AO。与非 AO 组相比，AO 组患者术前预设 LIV 旋转角度明显增大（8.8°±3.4°比 3.4°±2.9°，P<0.001）和 LIV+1（5.9°±4.0°比 3.6°±2.9°，P=0.004）、LIV+1/LIV 旋转差值（-2.6°±3.7°比 0.6°±3.2°，P<0.001）和术后 LIV 旋转角度（7.2°±4.3°比 3.0°±2.9°，P<0.001）。在 148 例选择最后触及椎体（LSTV）作为 LIV 的患者中，AO 组的上述参数也明显大于非 AO 组。多变量分析显示，Risser 分级和术前预设 LIV 旋转角度是 AO 的独立预测因素。
Risser 分级低和术前预设 LIV 旋转角度大的 AIS 患者在 sPTF 后更有可能发生 AO。此外，对于将 LSTV 选择为 LIV 的患者，术前预设 LIV 的旋转可能仍然是与 AO 发生相关的危险因素。
III 这些幻灯片可在电子补充材料中检索。
