青少年特发性脊柱侧凸患者胸腰椎椎体数量的变异：一项回顾性观察研究
Variations in the Number of Thoracic and Lumbar Vertebrae in Patients With Adolescent Idiopathic Scoliosis: A Retrospective, Observational Study.
作者信息
Garg Bhavuk, Mehta Nishank, Goyal Archit, Rangaswamy Namith, Upadhayay Arpan
机构信息
Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
出版信息
Int J Spine Surg. 2021 Apr;15(2):359-367. doi: 10.14444/8047. Epub 2021 Apr 1.
BACKGROUND
Abnormal anatomy is a contributory factor to wrong-level surgery. Variations in the number of vertebrae in populations from different races and geographical regions have been described. A ∼10% prevalence of variations in number of thoracic and lumbar vertebrae in adolescent idiopathic scoliosis (AIS) patients has been previously reported. The objectives of present study were (i) to find out the prevalence of variations in the number of thoracic and lumbar vertebrae and the presence of lumbosacral transitional vertebrae (LSTV) in Indian AIS patients and (ii) to correlate these variations with gender and type of curve.
METHODS
Hospital records and imaging of 198 AIS patients were reviewed retrospectively. A standardized numbering strategy was used to identify the number of thoracic vertebrae, number of lumbar vertebrae, and presence of LSTV. Patients' gender and curve type were correlated with the presence of an abnormal number of thoracic or lumbar vertebrae. Radiology reports and operation notes were reviewed to find out instances when the radiologist or surgeon had identified an abnormal number of vertebrae.
RESULTS
Forty patients (20.2%) with abnormally numbered thoracic or lumbar vertebrae were identified. Twenty patients (10.1%) had abnormally numbered thoracic vertebrae, and 33 patients (16.7%) had abnormally numbered lumbar vertebrae. The prevalence of LSTV was 18.2%. Presence of variations did not correlate with gender or curve type. Radiology reports identified 2/40 patients with variations, whereas operation notes showed 4/40 patients had been correctly identified to have abnormally numbered vertebrae.
CONCLUSIONS
There is high prevalence of variation in the number of thoracic or lumbar vertebrae in AIS patients, with most of those missed being identified by radiologists or surgeons. The patient's preoperative imaging must be scrutinized to identify these patients and take the variation into account to avoid wrong selection of fusion levels.
LEVEL OF EVIDENCE
CLINICAL RELEVANCE
Text. The study raises awareness about possibility of wrong selection in fusion levels due to anatomical variations in surgery for AIS.
背景
解剖结构异常是导致手术节段错误的一个因素。不同种族和地理区域人群的椎体数量变异已被描述。此前有报道称，青少年特发性脊柱侧凸（AIS）患者中胸腰椎椎体数量变异的患病率约为10%。本研究的目的是：（i） 了解印度AIS患者胸腰椎椎体数量变异及腰骶部移行椎（LSTV）的存在情况；（ii） 将这些变异与性别及侧弯类型相关联。
方法
回顾性分析198例AIS患者的医院记录和影像学资料。采用标准化编号策略来确定胸椎数量、腰椎数量及LSTV的存在情况。将患者的性别和侧弯类型与胸腰椎椎体数量异常的情况相关联。查阅放射学报告和手术记录，以找出放射科医生或外科医生识别出椎体数量异常的病例。
结果
共识别出40例（20.2%）胸腰椎椎体编号异常的患者。20例（10.1%）胸椎编号异常，33例（16.7%）腰椎编号异常。LSTV的患病率为18.2%。变异的存在与性别或侧弯类型无关。放射学报告识别出2/40例有变异的患者，而手术记录显示4/40例患者被正确识别为椎体编号异常。
结论
AIS患者中胸腰椎椎体数量变异的患病率较高，大多数未被发现的变异病例是由放射科医生或外科医生识别出来的。必须仔细检查患者的术前影像，以识别这些患者，并考虑到变异情况，避免融合节段选择错误。
证据水平
3级。
临床意义
文本。该研究提高了人们对AIS手术中由于解剖变异导致融合节段选择错误可能性的认识。
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