Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, 660 Euclid Avenue, Campus Box 8233, Saint Louis, MO, 63110, USA.
Department of Orthopaedic Surgery, Mahidol University, Bangkok, Thailand.
Spine Deform. 2021 May;9(3):721-731. doi: 10.1007/s43390-020-00228-9. Epub 2021 Mar 2.
Retrospective cohort.
Assess radiographically the effect of an all-posterior approach on correction of coronal balance in primary adult thoracolumbar spinal deformities based on Bao's classification of coronal imbalance with a focus on lumbosacral curve correction. Achieving appropriate coronal alignment is difficult in adults with coronal malalignment due to trunk shift ipsilateral to degenerated thoracolumbar scoliosis' apex.
Review of adults who underwent posterior spinal fusions to pelvis (≥ 5 levels) for thoracolumbar scoliosis. Exclusion: revisions, no coronal deformity, thoracic Cobb > 30°, and anterior operations. Patients were divided into three groups, as proposed by Bao et al.: type A: CSVL < 3 cm; type B: CSVL > 3 cm and C7 plumb shifted to scoliosis' concavity; type C: CSVL > 3 cm and C7 plumb shifted to scoliosis' convexity. Radiographic parameters and surgical techniques were compared.
124 patients (male-6; female-118; avg. age 58 ± 10 years; type A-87; type B-19; type C-18). Type C had significantly greater lumbosacral fractional curves. 28% of type C were treated with fractional curve TLIFs, while all, but one, type B had TLIFs of the fractional curve. Deformity parameters after surgery were similar, except type C had persistently greater fractional curves/coronal malalignment. All preop type B were appropriately corrected postop. For preop type C, 67% remained type C and 33% became type A postop. Compared to those who became type A, persistently undercorrected and malaligned (type C) patients had significantly greater preop lumbosacral fractional curves, greater preop coronal Cobb angles, and more commonly involved TLIFs of lumbosacral fractional curves. Compared to no interbody support, use of TLIFs provided better correction of the lumbosacral curve.
In adults with primary, posterior-only operations for thoracolumbar spinal deformity, 67% of type C coronal deformities and 20% of type A deformities remained or had worse coronal malalignment postop. While the use of TLIFs improved correction of the lumbosacral curve compared to no interbody support, alternative surgical strategies should be considered to more adequately correct lumbosacral fractional curves and balance correction of lumbosacral and major thoracolumbar curves so as to maintain and/or restore coronal balance.
III.
回顾性队列研究。
根据 Bao 对冠状失平衡的分类，评估全后路入路对原发性成人胸腰椎脊柱畸形冠状平衡矫正的影像学效果，重点关注腰骶曲线矫正。由于退行性胸腰椎脊柱侧凸顶点同侧躯干移位，冠状失平衡的成人很难获得适当的冠状对线。
回顾性分析接受后路脊柱融合骨盆（≥5 个节段）治疗胸腰椎脊柱侧凸的成人患者。排除标准：翻修手术、无冠状畸形、胸 Cobb>30°以及前路手术。患者分为 Bao 等提出的三组：A型：CSVL<3cm；B 型：CSVL>3cm 且 C7 铅垂线移至脊柱侧凸凹侧；C 型：CSVL>3cm 且 C7 铅垂线移至脊柱侧凸凸侧。比较影像学参数和手术技术。
124 例患者（男 6 例，女 118 例；平均年龄 58±10 岁；A型 87 例，B 型 19 例，C 型 18 例）。C 型患者腰骶部分段曲线明显较大。28%的 C 型患者行分段曲线 TLIFs 治疗，而所有 B 型患者（除 1 例外）均行分段曲线 TLIFs 治疗。术后畸形参数相似，但 C 型患者的分段曲线/冠状失平衡持续较大。术前所有 B 型患者均得到适当矫正，术后均为 B 型。对于术前 C 型患者，67%仍为 C 型，33%为 A 型。与转为 A 型的患者相比，持续矫正不足和失平衡（C 型）的患者术前腰骶部分段曲线明显较大，冠状 Cobb 角更大，更常行腰骶部分段曲线 TLIFs。与无椎间支撑相比，TLIFs 的使用提供了更好的腰骶曲线矫正。
在接受原发性、后路手术治疗胸腰椎脊柱畸形的成人中，67%的 C 型冠状畸形和 20%的 A 型畸形术后仍存在或出现更严重的冠状失平衡。与无椎间支撑相比，TLIFs 的使用改善了腰骶曲线的矫正，但应考虑其他手术策略，以更充分地矫正腰骶部分段曲线和平衡矫正腰骶部和主要胸腰椎曲线，从而维持和/或恢复冠状平衡。
III 级。
