Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, USA.
Spine Deform. 2021 Jul;9(4):1053-1062. doi: 10.1007/s43390-020-00276-1. Epub 2021 Jan 13.
The advantage of considering the three-dimensional curve patterns, including the patterns of the vertebral position and alignment, in classification of adolescent idiopathic scoliosis (AIS) patients and whether such classification system relates to the surgical outcomes are not fully determined.
A total of 371 AIS patients who received posterior spinal fusion surgery with 2-year follow-up were included retrospectively and consecutively. The 3D positions and orientations of the T1-L5 vertebrae were calculated from the 3D reconstructions of the spines at pre-operative and 2-year follow-up, a total of 102 variables per patient. A probabilistic clustering method was used to cluster the pre-operative and 2-year follow-up 3D spinal curve patterns separately. The distributions of the Lenke types and 3D pre-operative clusters in the post-operative clusters were determined.
A total of nine pre-operative clusters including, four right thoracic types, three left thoracolumbar/lumbar types, one low apex right thoracic/thoracolumbar, and one left thoracic/right lumbar were determined. Three post-operative 3D curve patterns were Type 1 with higher residual proximal Cobb angle, Type 2 with lower T5-T12 kyphosis and highest pelvic incidence-lordosis mismatch, and Type 3 with larger lumbar curve magnitude and rotation compared to the other two groups. More than 50% of patients in each of the 3D pre-operative clusters had the same post-operative group.
We developed a 3D classification of the AIS patients before and two-year after spinal fusion surgery. The link between the pre- and post-operative clusters lends itself to application of this classification system in developing predictive models of the AIS surgical outcomes.
在青少年特发性脊柱侧凸（AIS）患者的分类中，考虑三维曲线模式（包括椎体位置和排列的模式）的优势以及这种分类系统是否与手术结果相关尚未完全确定。
回顾性连续纳入 371 例接受后路脊柱融合术且随访 2 年的 AIS 患者。从脊柱的三维重建中计算 T1-L5 椎体的三维位置和方向，每位患者共 102 个变量。使用概率聚类方法分别对术前和 2 年随访的三维脊柱曲线模式进行聚类。确定术后聚类中 Lenke 类型和三维术前聚类的分布。
共确定了九个术前聚类，包括四个右胸型、三个左胸腰椎/腰椎型、一个低顶右胸腰椎/腰椎型和一个左胸/右腰型。三种术后三维曲线模式为：1 型具有较高的残余近端 Cobb 角，2 型具有较低的 T5-T12 后凸和最高的骨盆入射角-腰椎前凸不匹配，3 型与其他两组相比，腰椎曲线幅度和旋转较大。在每个三维术前聚类中，超过 50%的患者具有相同的术后组。
我们建立了 AIS 患者术前和脊柱融合术后两年的三维分类。术前和术后聚类之间的联系使其能够将该分类系统应用于 AIS 手术结果的预测模型的开发。
