Faldini Cesare, Barile Francesca, Perna Fabrizio, Pasini Stefano, Fiore Michele, Viroli Giovanni, Di Martino Alberto, Ruffilli Alberto
Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Dipartimento Rizzoli Sicilia, IRCCS Istituto Ortopedico Rizzoli, Bagheria, Italy.
Eur Spine J. 2021 Dec;30(12):3509-3516. doi: 10.1007/s00586-021-06897-y. Epub 2021 Jun 17.
The aim of this article is to present an original surgical technique for the treatment of rigid Adult Idiopathic Scoliosis (AdIS) and the results at minimum 2 years follow-up in a cohort of 40 patients.
We retrospectively reviewed 40 patients affected by rigid AdIS, older than 40 years and operated with a posterior one stage surgical technique summarized with the acronym Hi-PoAD, (high-density pedicle screws, Ponte osteotomies, asymmetric rods contouring, direct vertebral rotation). The demographic and surgical data were collected, and the improvement of clinical scores and radiologic parameters was obtained after surgery, at 1 and 2 years and at final follow-up, to assess deformity correction, coronal and sagittal balance and clinical outcome.
The average follow-up was 2.9 years (range 2-3.5). Average coronal Cobb angle decreased from 65.0° ± 8.4 to 18.9° ± 3.9 (p < 0.01). Rotation sagittal angle decreased from 26.2° ± 4.4° to 12.4° ± 2.8° (p < 0.01). Mean thoracic kyphosis improved from 23.1° ± 3.6° to 36.0° ± 3.9°. SRS-22 improved form 2.9 ± 0.4 to 3.7 ± 0.6 (p < 0.01). Four early post-operative deep wound infections were observed, all healed after debridement and implant retention. No mechanical complication, junctional kyphosis, deformity progression or non-union were recorded at the last follow-up.
Hi-PoAD technique proved to be safe and effective in the treatment of rigid Adult Idiopathic Scoliosis. The reason for the success is related to the combined strategies adopted, that dissipates corrective forces over several levels, reducing mechanical stress at the screw-bone interface and optimizing corrective potential.
本文旨在介绍一种治疗僵硬型成人特发性脊柱侧凸（AdIS）的原创手术技术，并报告40例患者至少2年随访结果。
我们回顾性分析了40例年龄大于40岁、采用一种缩写为Hi-PoAD（高密度椎弓根螺钉、Ponte截骨术、不对称棒材塑形、直接椎体旋转）的后路一期手术技术治疗的僵硬型AdIS患者。收集患者的人口统计学和手术数据，并在术后1年、2年及末次随访时获取临床评分和影像学参数的改善情况，以评估畸形矫正、冠状面和矢状面平衡以及临床疗效。
平均随访时间为2.9年（范围2 - 3.5年）。平均冠状面Cobb角从65.0°±8.4°降至18.9°±3.9°（p < 0.01）。旋转矢状角从26.2°±4.4°降至12.4°±2.8°（p < 0.01）。平均胸椎后凸角从23.1°±3.6°改善至36.0°±3.9°。SRS-22评分从2.9±0.4提高至3.7±0.6（p < 0.01）。观察到4例早期术后深部伤口感染，经清创和保留植入物后均愈合。末次随访时未记录到机械并发症、交界性后凸、畸形进展或骨不连。
Hi-PoAD技术在治疗僵硬型成人特发性脊柱侧凸方面被证明是安全有效的。成功的原因与所采用的联合策略有关，该策略可在多个节段分散矫正力，减少螺钉-骨界面的机械应力并优化矫正潜力。
