Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
Spine (Phila Pa 1976). 2020 Sep 15;45(18):1269-1276. doi: 10.1097/BRS.0000000000003513.
A prospective analysis.
To investigate whether the hyper-selective posterior fusion (upper instrumented vertebra [UIV] as the vertebra one level below the upper end vertebra [UEV], lower instrumented vertebra [LIV] as the lower end vertebra [LEV]) was applicable in posterior fusion of Lenke 5C adolescent idiopathic scoliosis (AIS) patients and what could be the indication of hyper-selective fusion.
The improper UIV selection in selective fusion could lead to progressive thoracic compensatory curve, shoulder imbalance, and even coronal imbalance. However, few studies analyzed the clinical outcome of hyper-selective fusion.
A prospective analysis of 80 patients with Lenke 5C AIS who underwent selective fusion was performed. According to the relationship between UEV and UIV, the patients were divided into UEV group (UIV = UEV) and UEV-1 group (UIV = UEV-1). Radiographic parameters and the incidence of postoperative proximal decompensation were compared. The Scoliosis Research Society (SRS)-22 scores were used to evaluate clinical outcomes between two groups.
Thirteen patients (27%) in UEV group and six (18.75%) in UEV-1 group showed proximal decompensation during follow-up, and the incidence was equivalent (P = 0.280). Within the UEV-1 group, the patients with proximal decompensation showed similar Risser grade, baseline thoracic Cobb angle, and main Cobb angle (P = 0.611, 0.435, 0.708, respectively). However, the baseline L-T apical vertebral translation (AVT) ratio was significantly larger in patients with proximal decompensation (P = 0.028). Meanwhile, patients with proximal decompensation in UEV group showed significantly smaller preoperative UIV translation and lumbar AVT but similar postoperative UIV tilt.
Hyper-selective posterior fusion strategy could be performed in Lenke 5C patients with Risser more than grade 2 and with thoracic compensatory curve over 15°. The UIV in patients with small baseline thoracic curve, represented by larger baseline lumbar-thoracic AVT ratio, should be selected as UEV to prevent proximal decompensation.
前瞻性分析。
探讨超选择性后路融合（上固定椎[UIV]作为上终椎[UEV]下一椎体，下固定椎[LIV]作为下终椎[LEV]）在后路融合治疗 Lenke 5C 型青少年特发性脊柱侧凸（AIS）患者中的适用性，以及超选择性融合的适应证。
选择性融合中 UIV 选择不当可导致胸段代偿性曲线进展、双肩不平衡，甚至冠状面失衡。然而，很少有研究分析超选择性融合的临床结果。
对 80 例接受选择性融合的 Lenke 5C AIS 患者进行前瞻性分析。根据 UEV 与 UIV 的关系，将患者分为 UEV 组（UIV = UEV）和 UEV-1 组（UIV = UEV-1）。比较两组患者术后近端代偿的影像学参数和发生率。采用脊柱侧凸研究协会（SRS）-22 评分评估两组患者的临床疗效。
UEV 组中有 13 例（27%）和 UEV-1 组中有 6 例（18.75%）患者在随访中出现近端代偿，发生率相当（P = 0.280）。在 UEV-1 组中，近端代偿患者的 Risser 分级、基线胸弯 Cobb 角和主弯 Cobb 角相似（P = 0.611、0.435、0.708）。然而，近端代偿患者的基线 L-T 顶椎位移（AVT）比值显著更大（P = 0.028）。同时，UEV 组中出现近端代偿的患者术前 UIV 位移和腰椎 AVT 明显较小，但术后 UIV 倾斜度相似。
对于 Risser 分级大于 2 级和胸段代偿性曲线大于 15°的 Lenke 5C 型患者，可以采用超选择性后路融合策略。对于基线胸段曲线较小的患者（表现为更大的基线腰椎-胸段 AVT 比值），应选择 UIV 作为 UEV，以防止近端代偿。
4 级。
