Department of Paediatric Orthopaedics and Traumatology, Medical University of Bialystok, The Faculty of Medicine, Bialystok, Poland.
Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
World Neurosurg. 2020 Nov;143:e464-e473. doi: 10.1016/j.wneu.2020.07.183. Epub 2020 Aug 1.
Temporary placement of an internal distraction rod is one of the surgical options in the treatment of severe scoliosis to avoid preoperative halo traction or vertebral column resection. This technique can be applied in a single session or staged. The aim of our study was to report the outcomes of less-invasive temporary internal distraction (LI-TID) in the surgical treatment of adolescents with severe idiopathic scoliosis (IS).
We performed a single-center, retrospective study of 22 adolescents (19 girls; mean age, 14.8 ± 2.0 years) with severe IS (major curve, ≥90°) who had undergone LI-TID, followed by staged pedicle screw instrumentation, with a minimum of 2 years of follow-up available. The demographic data, radiographic outcomes, pulmonary function test results, perioperative data, revised 22-item Scoliosis Research Society Outcomes questionnaire results, complications, and neuromonitoring data were collected.
The average major curve was 120° (range, 90°-160°) preoperatively and 59° (range, 29°-69°) at the final follow-up examination. Thoracic kyphosis (T5-T12) had improved from an average of 80° preoperatively to 33° postoperatively (range, 22°-69°), and the spinal height (T1-S1) had increased from 332 mm (range, 198-432 mm) preoperatively to 405 mm (range, 258-495 mm) at the final follow-up visit. Of the 22 patients, 5 (22.7%) had experienced an intraoperative neuromonitoring change without postoperative neurologic deficits, and 2 had developed superior mesenteric artery syndrome, with resolution after conservative treatment. The mean percentage of the predicted forced vital capacity had improved from 44.5% ± 11.3% to 66.5 ± 10.8 at final follow-up (P < 0.05). The total questionnaire score had improved significantly from 2.9 ± 0.61 to 4.1 ± 0.44 (P < 0.05).
The results from the present study have shown that staged LI-TID, followed by pedicle screw instrumentation, is safe and effective in adolescents with severe IS, with improvements in spinal deformity, pulmonary function, and health-related quality of life.
在重度脊柱侧凸的治疗中，临时内置撑开器的放置是一种手术选择，可以避免术前 halo 牵引或脊柱切除术。该技术可以单次或分期应用。我们的研究目的是报告微创临时内置撑开（LI-TID）在青少年重度特发性脊柱侧凸（IS）手术治疗中的结果。
我们对 22 名青少年（19 名女孩；平均年龄 14.8 ± 2.0 岁）进行了单中心回顾性研究，这些青少年患有重度 IS（主曲线≥90°），接受了 LI-TID 治疗，随后进行分期椎弓根螺钉内固定，随访至少 2 年。收集了人口统计学数据、影像学结果、肺功能检查结果、围手术期数据、修订后的 22 项脊柱侧凸研究协会结果问卷结果、并发症和神经监测数据。
术前平均主曲线为 120°（范围 90°-160°），末次随访时为 59°（范围 29°-69°）。胸椎后凸（T5-T12）从术前平均 80°改善至术后 33°（范围 22°-69°），脊柱高度（T1-S1）从术前 332mm（范围 198-432mm）增加至末次随访时的 405mm（范围 258-495mm）。22 名患者中有 5 名（22.7%）术中出现神经监测改变，但无术后神经功能缺损，2 名发生肠系膜上动脉综合征，经保守治疗后缓解。末次随访时预计用力肺活量的百分比从 44.5%±11.3%提高到 66.5%±10.8%（P<0.05）。问卷总分从 2.9±0.61 显著提高至 4.1±0.44（P<0.05）。
本研究结果表明，分期 LI-TID 后行椎弓根螺钉内固定治疗重度 IS 是安全有效的，可改善脊柱畸形、肺功能和健康相关生活质量。
