Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) , Faculty of Medicine, University of Malaya , 50603, Kuala Lumpur, Malaysia.
Eur Spine J. 2021 Jul;30(7):1978-1987. doi: 10.1007/s00586-021-06874-5. Epub 2021 May 22.
To investigate mid-long-term effects of the lowest instrumented vertebra (LIV) selection on adolescent idiopathic scoliosis (AIS) patients who had posterior spinal fusion (PSF) surgery.
Forty-eight patients were recruited. Inclusion criteria were AIS patients who have had PSF surgery more than 10 years ago. Patients were divided into G1: LIV L3 or higher and G2: LIV L4 or lower. MRI evaluation was classified using Pfirrmann grades. Pfirrmann scores were average of Pfirrmann grades for all unfused discs below LIV. SRS-22r, SF-36, Oswestry Disability Index (ODI) and Modified Cincinnati Sports Activity Scale (MCSAS) were used.
There were 19 patients in G1 and 29 patients in G2. Demographic parameters showed no significant differences. We found no significant differences in Pfirrmann grades or scores between G1 and G2. There was significant correlation between age and mean Pfirrmann scores (r = 0.546, p < 0.001), Pfirrmann grade for adjacent disc + 1 below LIV (r = 0.475, p = 0.001) and adjacent disc below LIV (r = 0.365, p = 0.011). G2 had significantly lower scores for SRS-22r pain (G1: 4.3 ± 0.5, G2: 4.0 ± 0.6, p = 0.044) and the SF-36 bodily pain (G1: 88.7 ± 12.3, G2: 77.8 ± 18.7, p = 0.018) domains. There were no significant differences in ODI and MCSAS between the two groups.
Patients with fusion to L4 or lower had more significant back pain. However, both groups had similar physical function, self-image, satisfaction with treatment, mental health, and functional sports activity. We did not find any significant association between lumbar discs degeneration and the selection of LIV.
研究后路脊柱融合术（PSF）治疗青少年特发性脊柱侧凸（AIS）患者选择最低固定椎（LIV）的中远期效果。
纳入 48 例患者。纳入标准为 PSF 术后 10 年以上的 AIS 患者。患者分为 G1：LIV L3 或更高；G2：LIV L4 或更低。使用 Pfirrmann 分级进行 MRI 评估。LIV 以下所有未融合节段的 Pfirrmann 评分取平均值。使用 SRS-22r、SF-36、Oswestry 残疾指数（ODI）和改良辛辛那提运动活动量表（MCSAS）进行评估。
G1 组 19 例，G2 组 29 例。两组的人口统计学参数无显著差异。G1 组和 G2 组的 Pfirrmann 分级或评分无显著差异。年龄与平均 Pfirrmann 评分（r=0.546，p<0.001）、LIV 以下邻近节段+1 的 Pfirrmann 分级（r=0.475，p=0.001）和 LIV 以下邻近节段的 Pfirrmann 分级（r=0.365，p=0.011）呈显著相关。G2 组 SRS-22r 疼痛评分（G1：4.3±0.5，G2：4.0±0.6，p=0.044）和 SF-36 躯体疼痛评分（G1：88.7±12.3，G2：77.8±18.7，p=0.018）明显较低。两组的 ODI 和 MCSAS 评分无显著差异。
融合至 L4 或更低节段的患者腰痛更明显。然而，两组患者的躯体功能、自我形象、治疗满意度、心理健康和功能性运动活动均无显著差异。我们未发现腰椎间盘退变与 LIV 选择之间存在显著相关性。
