Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
Spine (Phila Pa 1976). 2021 Apr 15;46(8):E491-E497. doi: 10.1097/BRS.0000000000003820.
A retrospective study.
The aim of this study was to investigate the incidence and risk factors for distal adding-on (AO) phenomenon after posterior spinal fusion (PSF) in scoliosis secondary to Chiari malformation type I (CMS) patients with right major thoracic curve.
Distal AO phenomenon is a common complication observed in adolescent idiopathic scoliosis (AIS), which is significantly associated with unsatisfactory outcomes. However, few studies specifically focused on the incidence and risk factors of distal AO in CMS.
Seventy-eight CMS adolescents were included with a minimum of 2-year follow-up after PSF. patients with distal AO at the final follow-up were divided into AO group and those without were No-AO group. The coronal and sagittal parameters were evaluated preoperatively, immediately after surgery, and at the last follow-up. Clinical outcome was analyzed using the Chicago Chiari Outcome Scale (CCOS).
Distal AO was observed in 18 of 78 patients (23.1%). Compared with No-AO group, patients with distal AO had significantly lower Risser sign (P = 0.001), more flexibility of lumbar curve (P = 0.021), higher incidence of lowest instrumented vertebra-last substantially touched vertebra (LIV-LSTV) ≤0 (P = 0.001), smaller postoperative Cobb angle of lumbar curve (P < 0.001), and greater correction rate of lumbar curve (P = 0.001). Logistic regression analysis revealed that low Risser sign (Grade 1-2, odds ratio [OR] = 5.7, P = 0.029) and LIV-LSTV ≤0 (OR = 6.4, P = 0.019) were independent risk factors for distal AO. There was no significant difference of CCOS scores between two groups at the final follow-up (P > 0.05 for all).
The incidence of distal AO was 23.1% in CMS patients after PSF. Patients with low Risser sign and LIV-LSTV ≤0 were high risk factors for distal AO.Level of Evidence: 3.
回顾性研究。
本研究旨在探讨 Chiari 畸形 I 型（CMS）合并右胸主弯的脊柱后融合（PSF）后远端附加（AO）现象的发生率及危险因素。
远端 AO 现象是青少年特发性脊柱侧凸（AIS）中常见的并发症，与不满意的结果显著相关。然而，很少有研究专门针对 CMS 中远端 AO 的发生率和危险因素进行研究。
纳入 78 例 CMS 青少年患者，PSF 后至少随访 2 年。在最终随访时出现远端 AO 的患者分为 AO 组，无远端 AO 的患者分为 No-AO 组。术前、术后即刻和末次随访时评估冠状面和矢状面参数。采用芝加哥 Chiari 结局量表（CCOS）分析临床结果。
78 例患者中，18 例（23.1%）出现远端 AO。与 No-AO 组相比，远端 AO 组的 Risser 征明显较低（P=0.001），腰椎曲线的柔韧性更高（P=0.021），最低固定椎-最后实际接触椎（LIV-LSTV）≤0 的发生率更高（P=0.001），术后腰椎曲线 Cobb 角更小（P<0.001），腰椎曲线矫正率更大（P=0.001）。Logistic 回归分析显示，低 Risser 征（1-2 级，比值比[OR] = 5.7，P=0.029）和 LIV-LSTV≤0（OR = 6.4，P=0.019）是远端 AO 的独立危险因素。两组患者在末次随访时的 CCOS 评分无显著差异（P>0.05）。
CMS 患者 PSF 后远端 AO 的发生率为 23.1%。低 Risser 征和 LIV-LSTV≤0 的患者是远端 AO 的高危因素。
3 级
