IWK Health Centre, Halifax, NS, Canada.
Orthopedics Department, Zagazig University, Zagazig.
J Pediatr Orthop. 2021;41(5):290-295. doi: 10.1097/BPO.0000000000001784.
It is unclear whether the type of proximal anchor affects the spine length achieved with distraction-based surgeries in patients with nonidiopathic early-onset scoliosis (EOS). Since distraction may produce kyphosis, spine length should be assessed in the sagittal plane using the sagittal spine length (SSL-curved arc length of the spine in the sagittal plane). Our purpose was to determine if the type of proximal anchor in distraction-based surgeries will affect final spine length.
Patients with nonidiopathic EOS treated with distraction-based systems (minimum 5 y follow-up, 5 lengthenings) were identified from 2 EOS registries. Radiographic analysis preoperative, postimplant (L1), and after each lengthening (L2-L5, L6-L10, L11-L15) was performed with the primary outcome of T1-S1 SSL.
We identified 126 patients-70 had rib-based implants (52 congenital, 9 syndromic, 9 neuromuscular) and 56 had spine-based implants (15 congenital, 29 syndromic, 12 neuromuscular) with preoperative age 4.6 years, scoliosis 75 degrees, and kyphosis 48 degrees. After initial correction (P<0.05), scoliosis remained constant [58 degrees (13 to 104 degrees) at L11-L15] and kyphosis increased over time [38 degrees (9 to 108 degrees) at L1 to 60 degrees (17 to 134 degrees) at L11-L15] (P<0.05). Preoperative SSL was higher in the spine-based group (29.6 cm) when compared with the rib-based group (25.2 cm) (P<0.05). This difference was maintained after initial implantation (spine-based: 32.2 cm vs. rib-based: 26.7 cm, P<0.05) and at final follow-up (spine-based: 37.0 cm vs. rib-based: 34.4 cm, P<0.05). As preoperative SSL differed between groups, maximum SSL gains per interval were also normalized to preoperative SSL. There was no statistically significant difference between groups at L1, L2-L5, and L6-L10. However, at L11-L15, the rib-based group achieved a more relative increase in spine length compared with the spine-based group (45% vs. 31%, P<0.05).
At minimum 5 year follow-up, distraction-based surgeries increased spine length for patients with nonidiopathic EOS; regardless of proximal anchor type.
目前尚不清楚近端锚定物的类型是否会影响非特发性早发性脊柱侧凸（EOS）患者在基于牵开的手术中所获得的脊柱长度。由于牵开可能会导致后凸，因此应在矢状面中使用矢状脊柱长度（SSL-脊柱在矢状面中的弯曲弧长）来评估脊柱长度。我们的目的是确定基于牵开的手术中的近端锚定物的类型是否会影响最终的脊柱长度。
从两个 EOS 注册中心中确定了接受基于牵开的系统治疗的非特发性 EOS 患者（至少 5 年随访，5 次延长）。术前、植入后（L1）和每次延长后（L2-L5、L6-L10、L11-L15）均进行影像学分析，主要结果为 T1-S1 SSL。
我们共确定了 126 例患者，其中 70 例患者使用了肋骨基植入物（52 例先天性，9 例综合征，9 例神经肌肉），56 例患者使用了脊柱基植入物（15 例先天性，29 例综合征，12 例神经肌肉），术前年龄为 4.6 岁，脊柱侧凸为 75°，后凸为 48°。初次矫正后（P<0.05），脊柱侧凸保持不变[L11-L15 处 58°（13-104°）]，后凸随时间增加[L1 处 38°（9-108°）至 L11-L15 处 60°（17-134°）]（P<0.05）。与肋骨基组相比，脊柱基组的术前 SSL 更高（29.6cm 比 25.2cm）（P<0.05）。这一差异在初次植入后（脊柱基：32.2cm 比肋骨基：26.7cm，P<0.05）和最终随访时（脊柱基：37.0cm 比肋骨基：34.4cm，P<0.05）仍保持不变。由于术前 SSL 在两组之间存在差异，因此每个间隔的最大 SSL 增益也被归一化为术前 SSL。在 L1、L2-L5 和 L6-L10 处，两组之间无统计学差异。然而，在 L11-L15 处，肋骨基组与脊柱基组相比，脊柱长度的相对增加更为显著（45%比 31%）（P<0.05）。
至少 5 年的随访结果表明，非特发性 EOS 患者接受基于牵开的手术治疗后脊柱长度增加；与近端锚定物类型无关。
