Department of Orthopaedic Surgery, G05.228, University Medical Center Utrecht, P.O. Box 85500, 35084 GA, Utrecht, The Netherlands.
Orthopaedic Department, Centre medico chirurgical Les Massues, Lyon, France.
Eur Spine J. 2021 Mar;30(3):645-652. doi: 10.1007/s00586-020-06659-2. Epub 2020 Dec 23.
There are distinct differences in strategy amongst experienced surgeons from different 'scoliosis schools' around the world. This study aims to test the hypothesis that, due to the 3-D nature of AIS, different strategies can lead to different coronal, axial and sagittal curve correction.
Consecutive patients who underwent posterior scoliosis surgery for primary thoracic AIS were compared between three major scoliosis centres (n = 193). Patients were treated according to the local surgical expertise: Two centres perform primarily an axial apical derotation manoeuvre (centre 1: high implant density, convex rod first, centre 2: low implant density, concave rod first), whereas centre 3 performs posteromedial apical translation without active derotation. Pre- and postoperative shape of the main thoracic curve was analyzed using coronal curve angle, apical rotation and sagittal alignment parameters (pelvic incidence and tilt, T1-T12, T4-T12 and T10-L2 regional kyphosis angles, C7 slope and the level of the inflection point). In addition, the proximal junctional angle at follow-up was compared.
Pre-operative coronal curve magnitudes were similar between the 3 cohorts and improved 75%, 70% and 59%, from pre- to postoperative, respectively (P < 0.001). The strategy of centres 1 and 2 leads to significantly more apical derotation. Despite similar postoperative T4-T12 kyphosis, the strategy in centre 1 led to more thoracolumbar lordosis and in centre 2 to a higher inflection point as compared to centre 3. Proximal junctional angle was higher in centres 1 and 2 (P < 0.001) at final follow-up.
Curve correction by derotation may lead to thoracolumbar lordosis and therefore higher risk for proximal junctional kyphosis. Focus on sagittal plane by posteromedial translation, however, results in more residual coronal and axial deformity.
来自世界各地不同“脊柱侧弯学派”的经验丰富的外科医生在策略上存在明显差异。本研究旨在验证以下假设，即由于 AIS 的三维性质，不同的策略可能导致不同的冠状面、轴向和矢状面曲线矫正。
对三个主要脊柱侧弯中心（n=193）连续接受后路脊柱侧弯手术治疗的原发性胸段 AIS 患者进行比较。患者根据当地的手术经验进行治疗：两个中心主要进行轴向顶点旋转矫正（中心 1：高植入物密度，凸侧棒先行，中心 2：低植入物密度，凹侧棒先行），而中心 3 则进行后正中顶点平移而不进行主动旋转矫正。使用冠状面曲线角度、顶点旋转和矢状面排列参数（骨盆入射角和倾斜角、T1-T12、T4-T12 和 T10-L2 区域后凸角、C7 斜率和拐点水平）分析主胸弯术前和术后的形状。此外，还比较了随访时近端交界角。
三组患者术前冠状面曲线幅度相似，术后分别改善 75%、70%和 59%（P<0.001）。中心 1 和 2 的策略导致明显更多的顶点旋转。尽管术后 T4-T12 后凸相似，但中心 1 的策略导致胸腰椎前凸增加，而中心 2 则导致拐点升高，与中心 3 相比。在最终随访时，中心 1 和 2 的近端交界角更高（P<0.001）。
通过旋转矫正曲线可能导致胸腰椎前凸，从而增加近端交界区后凸的风险。然而，通过后正中平移关注矢状面会导致更多的残余冠状面和轴向畸形。
