Department of Orthopedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan.
Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Spine (Phila Pa 1976). 2021 Sep 15;46(18):E976-E984. doi: 10.1097/BRS.0000000000003967.
A retrospective comparative study.
The aim of this study was to examine the changes in cervical sagittal alignment (CSA) following surgical correction in a patient with Lenke type 5 adolescent idiopathic scoliosis (AIS) and evaluate any possible factors influencing postoperative CSA.
Few studies have assessed the association between CSA and thoracic or lumbar sagittal alignment in AIS patients with major thoracolumbar/lumbar curve who underwent posterior correction and fusion surgery.
Sixty-six patients with Lenke type 5 AIS (two males and 64 females, the mean age at surgery of 16.2 years) were included in this study. They were followed up for minimum 5 years after surgery. Multiple linear regression analysis was used to evaluate possible factors influencing the postoperative CSA. To determine the influence of upper end vertebra (UEV) level on postoperative CSA, the subjects were divided into two groups according to UEV level of ≥T9 or ≤T10. The outcome variables were compared between the two groups and analyzed for changes in various spinal sagittal profiles using radiographic outcomes.
Multiple linear regression analysis revealed that preoperative T10-L2 kyphosis and LL were significantly correlated with postoperative C2-7 lordosis. However, CSA did not significantly change at 5 years after surgery. Sub-analysis of the cohort revealed that in the UEV ≥T9 group, the mean thoracic kyphosis significantly increased from 20.3° ± 10.6° to 24.0° ± 8.9° and the mean C2-7 lordosis also significantly increased from -12.5° ± 8.3° to -4.3° ± 10.3° at 5-year postoperatively. SRS-22 outcomes were comparable between the groups.
We indicated that the CSA was not influenced by surgical correction in most Lenke type 5 AIS patients. However, in a patient whose UEV was located at T9 or higher levels, CSA was influenced through the changes in thoracic kyphosis following posterior correction surgery.Level of Evidence: 4.
回顾性对比研究。
本研究旨在探讨 Lenke 5 型青少年特发性脊柱侧凸（AIS）患者行后路矫正融合术后颈椎矢状面排列（CSA）的变化，并评估可能影响术后 CSA 的相关因素。
既往研究中，对于行后路矫正融合术的胸椎或胸腰段/腰椎主弯较大的 AIS 患者，评估 CSA 与胸腰椎矢状面排列之间关系的研究较少。
本研究纳入了 66 例 Lenke 5 型 AIS 患者（2 例男性，64 例女性，平均手术年龄为 16.2 岁），所有患者术后均获得至少 5 年随访。采用多元线性回归分析评估可能影响术后 CSA 的相关因素。为了评估上终椎（UEV）水平对术后 CSA 的影响，根据 UEV 水平（≥T9 或≤T10）将患者分为两组。通过影像学结果比较两组之间的结果变量，分析各种脊柱矢状面曲线的变化。
多元线性回归分析显示，术前 T10-L2 后凸和骨盆倾斜角与术后 C2-7 前凸显著相关。然而，术后 5 年 CSA 并未显著改变。对队列的亚组分析表明，在 UEV≥T9 组中，胸椎后凸从术前的 20.3°±10.6°显著增加到术后的 24.0°±8.9°，C2-7 前凸从术前的-12.5°±8.3°显著增加到术后的-4.3°±10.3°。两组间 SRS-22 评分无显著差异。
我们发现，在大多数 Lenke 5 型 AIS 患者中，CSA 不受手术矫正的影响。然而，在 UEV 位于 T9 或更高水平的患者中，CSA 受后路矫正术后胸椎后凸变化的影响。
4 级。
