Clement Jean-Luc, Le Goff Ludovic, Oborocianu Ioana, Rosello Olivier, Bertoncelli Carlo, Solla Federico, Rampal Virginie
Department of Pediatric Orthopedics and Scoliosis Surgery, Hôpitaux Pédiatriques de Nice CHU Lenval, 57 Avenue de la Californie, Nice, France.
Eur Spine J. 2021 Dec;30(12):3550-3556. doi: 10.1007/s00586-021-06904-2. Epub 2021 Jun 27.
The modification of cervical lordosis (CL) after adolescent idiopathic scoliosis (AIS) surgery is influenced by the correction of thoracic hypokyphosis. The quantification of the increase of CL as a function of the increase of thoracic kyphosis (TK) has never been calculated.
A total of 92 consecutive AIS patients who underwent a posterior thoracic selective fusion, corrected by simultaneous translation on 2 rods technique, with minimum 24-month follow-up, were analyzed from a prospective database. We evaluated global sagittal kyphosis and lordosis. CL was divided by the horizontal line in proximal (PCL) and distal cervical lordosis (DCL), likewise TK in proximal (PTK) and distal TK (DTK), and lumbar lordosis (LL) in proximal (PLL) and distal LL (DLL).
The mean TK gain was 16°, 14° and 28° in the whole cohort, normokyphosis group and hypokyphosis group, respectively. The mean DCL gain was, respectively, 9°, 7° and 20° and the mean CL gain 8°, 5° and 21°. There was a strong correlation between TK gain and CL gain (coefficient = 0.86) and between TK gain and DCL gain (coefficient = 0.74). The regression equation was defined as DCLgain = - 3 + 0.75 × TKgain (p < 0.0001) corresponding on average to 60% of the TK gain.
60% of the TK gain was transferred to DCL gain. Correlations reflect the geometrical equivalence between PTK and DCL. The use of sagittal global measurements shows that DCL is equivalent to PTK and can be expressed as a function of pelvic parameters (DCL = PT + LL-PI). DCL must be considered to optimize the postoperative sagittal alignment of the spine.
青少年特发性脊柱侧凸（AIS）手术后颈椎前凸（CL）的改变受胸椎后凸不足矫正的影响。CL增加量与胸椎后凸（TK）增加量之间的量化关系从未被计算过。
从一个前瞻性数据库中分析了92例连续接受后路胸椎选择性融合术的AIS患者，这些患者采用双棒同步平移技术进行矫正，随访至少24个月。我们评估了整体矢状面后凸和前凸。CL被水平分为近端颈椎前凸（PCL）和远端颈椎前凸（DCL），同理，TK分为近端胸椎后凸（PTK）和远端胸椎后凸（DTK），腰椎前凸（LL）分为近端腰椎前凸（PLL）和远端腰椎前凸（DLL）。
在整个队列、正常后凸组和后凸不足组中，平均TK增加量分别为16°、14°和28°。平均DCL增加量分别为9°、7°和20°，平均CL增加量分别为8°、5°和21°。TK增加量与CL增加量之间（系数 = 0.86）以及TK增加量与DCL增加量之间（系数 = 0.74）存在强相关性。回归方程定义为DCL增加量 = - 3 + 0.75×TK增加量（p < 0.0001），平均相当于TK增加量的60%。
TK增加量的60%转移至DCL增加量。相关性反映了PTK与DCL之间的几何等效性。使用矢状面整体测量结果表明DCL等同于PTK，并且可以表示为骨盆参数的函数（DCL = PT + LL - PI）。为优化术后脊柱矢状面排列，必须考虑DCL。
