Department of Neurosurgery University of California, San Francisco, San Francisco, California, USA.
Department of Neurosurgery, University of California, Irvine, Irvine, California, USA.
World Neurosurg. 2021 Apr;148:e482-e487. doi: 10.1016/j.wneu.2021.01.011. Epub 2021 Jan 11.
Spinopelvic parameters have hitherto dictated much of adult spinal deformity (ASD) correction. The Roussouly classification is used for the normal adult spine. We evaluated whether a correlation would be found between the Roussouly type and the rate of revision surgery in patients with ASD undergoing circumferential minimally invasive spinal (cMIS) correction.
A multicenter retrospective review of patients who had undergone cMIS surgery for ASD was performed. The inclusion criteria were age ≥18 years and 1 of the following: coronal Cobb angle >20°, sagittal vertical axis >5 cm, pelvic tilt >20°, pelvic incidence (PI) to lumbar lordosis (LL) mismatch >10°, cMIS surgery, and a minimum of 2 years of follow-up data available. The patients were classified by Roussouly type, and the clinical and radiographic outcomes were evaluated.
A total of 104 patients were included in the present analysis. Of the 104 patients, 41 had Roussouly type 1, 32 had type 2, 23 had type 3, and 8 had type 4. Preoperatively, the patients with type 4 had the highest PI (P = 0.002) and LL (P < 0.001). Postoperatively, the PI-LL mismatch, Cobb angle, and sagittal vertical axis were not different among the 4 groups. However, the patients with type 2 had had the highest rate of complications (type 1, 29.3%; type 2, 61.3%; type 3, 34.8%; type 4, 25.0%; P = 0.031). The reoperation rates were comparable (type 1, 19.5%; type 2, 38.7%; type 3, 13.0%; type 4, 12.5%; P = 0.097). The reoperation rates for adjacent segment degeneration or proximal junctional kyphosis were also comparable (P = 0.204 and P = 0.060, respectively).
We did not find a clear correlation between Roussouly type and the rate of revision surgery for adjacent segment disease or proximal junctional kyphosis in patients who had undergone cMIS surgery for ASD.
脊柱骨盆参数一直主导着成人脊柱畸形（ASD）的矫正。Roussouly 分类用于正常成人脊柱。我们评估了 ASD 患者行环锯微创脊柱（cMIS）矫正术时，Roussouly 分型与翻修手术率之间是否存在相关性。
对接受 cMIS 手术治疗 ASD 的患者进行多中心回顾性研究。纳入标准为年龄≥18 岁且符合以下 1 项标准：冠状 Cobb 角>20°，矢状垂直轴>5cm，骨盆倾斜>20°，骨盆入射角（PI）与腰椎前凸（LL）不匹配>10°，行 cMIS 手术，且至少有 2 年随访数据。根据 Roussouly 分型对患者进行分类，并评估临床和影像学结果。
本研究共纳入 104 例患者。104 例患者中，Roussouly 分型 1 型 41 例，2 型 32 例，3 型 23 例，4 型 8 例。术前，4 型患者 PI 值最高（P=0.002），LL 值最高（P<0.001）。术后，4 组患者 PI-LL 不匹配、Cobb 角和矢状垂直轴均无差异。然而，2 型患者并发症发生率最高（1 型，29.3%；2 型，61.3%；3 型，34.8%；4 型，25.0%；P=0.031）。再次手术率相似（1 型，19.5%；2 型，38.7%；3 型，13.0%；4 型，12.5%；P=0.097）。相邻节段退变或近端交界性后凸的再次手术率也相似（P=0.204 和 P=0.060）。
我们未发现 ASD 患者行 cMIS 手术后，Roussouly 分型与相邻节段疾病或近端交界性后凸的翻修手术率之间存在明确相关性。
