1Department of Neurosurgery, Rutgers University, Newark, New Jersey.
2Department of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Pennsylvania.
J Neurosurg Pediatr. 2021 Apr 23;27(6):725-731. doi: 10.3171/2020.10.PEDS20671. Print 2021 Jun 1.
Spontaneous lumbar curve correction after selective thoracic fusion in surgery for adolescent idiopathic scoliosis (AIS) is well described. However, only a few articles have described the course of the uninstrumented upper thoracic (UT) curve after fusion, and the majority involve a hybrid construct. In this study, the authors sought to determine the outcomes and associated factors of uninstrumented UT curves in patients with AIS.
The authors retrospectively reviewed a prospectively collected multicenter AIS registry for all consecutive patients with Lenke type 1-4 curves with a 2-year minimum follow-up. UT curves were considered uninstrumented if the upper instrumented vertebra (UIV) did not extend above 1 level from the lower end vertebra of the UT curve. The authors defined progression as > 5°, and divided patients into two cohorts: those with improvement in the UT curve (IMP) and those without improvement in the UT curve (NO IMP). Radiographic, demographic, and Scoliosis Research Society (SRS)-22 survey outcome measures were compared using univariate analysis, and significant factors were compared using a multivariate regression model.
The study included 450 patients (370 females and 80 males). The UT curve self-corrected in 86% of patients (n = 385), there was no change in 14% (n = 65), and no patients worsened. Preoperatively, patients were similar with respect to Lenke classification (p = 0.44), age (p = 0.31), sex (p = 0.85), and Risser score (p = 0.14). The UT curves in the IMP group self-corrected from 24.7° ± 6.5° to 12.6° ± 5.9°, whereas in the NO IMP group UT curves remained the same, from 20.3° ± 5.8° to 18.5° ± 5.7°. In a multivariate analysis, preoperative main thoracic (MT) curve size (p = 0.004) and MT curve correction (p = 0.001) remained significant predictors of UT curve improvement. Greater correction of the MT curve and larger initial MT curve size were associated with greater likelihood of UT curve improvement.
Spontaneous UT curve correction occurred in the majority (86%) of unfused UT curves after MT curve correction in Lenke 1-4 curve types. The magnitude of preoperative MT curve size and postoperative MT curve correction were independent predictors of spontaneous UT curve correction.
选择性胸椎融合术治疗青少年特发性脊柱侧凸（AIS）后自发性腰椎曲线矫正已有很好的描述。然而，仅有少数几篇文章描述了融合后未矫正的上胸段（UT）曲线的过程，且大多数涉及混合结构。在这项研究中，作者试图确定 AIS 患者中未矫正的 UT 曲线的结果和相关因素。
作者回顾性分析了前瞻性收集的多中心 AIS 登记处的所有连续 Lenke 1-4 型曲线患者，随访时间至少 2 年。如果上矫正椎体（UIV）未从上 UT 曲线的下终椎向上延伸 1 个以上水平，则认为 UT 曲线未矫正。作者将进展定义为>5°，并将患者分为两组：UT 曲线改善组（IMP）和 UT 曲线无改善组（NO IMP）。使用单变量分析比较放射学、人口统计学和脊柱侧凸研究协会（SRS）-22 调查结果测量值，使用多变量回归模型比较有显著意义的因素。
该研究共纳入 450 例患者（370 例女性和 80 例男性）。86%的患者（n=385）的 UT 曲线自行矫正，14%的患者（n=65）曲线无变化，无患者恶化。术前，患者在 Lenke 分类（p=0.44）、年龄（p=0.31）、性别（p=0.85）和 Risser 评分（p=0.14）方面相似。IMP 组的 UT 曲线从 24.7°±6.5°自行矫正至 12.6°±5.9°，而 NO IMP 组的 UT 曲线保持不变，从 20.3°±5.8°至 18.5°±5.7°。多变量分析显示，术前主胸（MT）曲线大小（p=0.004）和 MT 曲线矫正（p=0.001）仍然是 UT 曲线改善的显著预测因素。MT 曲线更大的矫正和初始 MT 曲线更大的大小与 UT 曲线改善的可能性更大相关。
在 Lenke 1-4 型曲线类型中，MT 曲线矫正后，大多数（86%）未融合的 UT 曲线出现自发性 UT 曲线矫正。术前 MT 曲线大小和术后 MT 曲线矫正的幅度是自发性 UT 曲线矫正的独立预测因素。
