Department of Pediatric Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, ATTN: Michael Vitale, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA.
Department of Orthopedic Surgery, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
Spine Deform. 2020 Dec;8(6):1261-1267. doi: 10.1007/s43390-020-00166-6. Epub 2020 Jul 14.
Surgical planning for Adolescent Idiopathic Scoliosis (AIS) relies on the coronal and sagittal plane to determine the lowest instrumented vertebra (LIV). Failure to include the stable sagittal vertebra (SSV) within the construct can increase the incidence of postoperative distal junctional kyphosis (DJK). The purpose of this study is to assess the variability of SSV within patients and to identify positional parameters that may lead to its change.
This is a case-control study of AIS patients with changes in SSV throughout serial radiographs. Radiographic sagittal parameters and hand positioning for the patients with changes in SSV were compared to patients with stable SSV. Additionally, a subgroup analysis was conducted to compare the positional parameters of only the patients with changes in SSV.
46 patients with a mean age of 15 ± 1.8 years old at the time of surgery were included in this study. 33/76 (43.4%) image pairs were found to have a change in SSV. Positional parameters associated with the more distally measured SSV were found to have a more negative sagittal vertebral axis (p = 0.001), more positive pelvic shift (p = 0.023), and more negative Global Sagittal Axis (p = 0.001) when compared to the more proximally measured SSV.
Significant variability exists in the determination of SSV in AIS patients undergoing serial radiographs. Positional parameters associated with the proximal and distally measured SSV also have variability which indicates that posture has a significant impact on this measure. Surgeons need to be aware of SSV variability during preoperative planning and must consider multiple parameters for the determination of LIV.
青少年特发性脊柱侧凸（AIS）的手术规划依赖于冠状面和矢状面来确定最低置钉节段（LIV）。如果在固定结构中不包括稳定的矢状椎体（SSV），可能会增加术后远端交界性后凸（DJK）的发生率。本研究的目的是评估患者内 SSV 的可变性，并确定可能导致其变化的位置参数。
这是一项 AIS 患者的病例对照研究，其 SSV 在连续影像学中发生变化。比较了 SSV 发生变化的患者与 SSV 稳定的患者的影像学矢状参数和手的位置。此外，还进行了亚组分析，以比较仅 SSV 发生变化的患者的位置参数。
本研究共纳入 46 例患者，手术时平均年龄为 15±1.8 岁。发现 76 对图像中有 33 对（43.4%）SSV 发生变化。与近端测量的 SSV 相比，与更远处测量的 SSV 相关的位置参数具有更负的矢状椎体轴（p=0.001）、更正的骨盆移位（p=0.023）和更负的整体矢状轴（p=0.001）。
在接受连续影像学检查的 AIS 患者中，SSV 的确定存在显著差异。与近端和远端测量的 SSV 相关的位置参数也存在差异，这表明姿势对该测量有显著影响。外科医生在术前规划时需要意识到 SSV 的可变性，并且必须考虑多个参数来确定 LIV。
3 级
