J Neurosurg Spine. 2021 Jul 30;35(4):486-494. doi: 10.3171/2021.1.SPINE202086. Print 2021 Oct 1.
This study aimed to investigate reversal of vertebral wedging and to evaluate the contribution of vertebral remodeling to correction maintenance in patients with adolescent Scheuermann's kyphosis (SK) after posterior-only instrumented correction.
A retrospective cohort study of patients with SK was performed. In total, 45 SK patients aged 10-20 years at surgery were included. All patients received at least 24 months of follow-up and had Risser sign greater than grade 4 at latest follow-up. Patients with Risser grade 3 or less at surgery were assigned to the low-Risser group, whereas those with Risser grade 4 or 5 were assigned to the high-Risser group. Radiographic data and patient-reported outcomes were collected preoperatively, immediately postoperatively, and at latest follow-up and compared between the two groups.
Remarkable postoperative correction of global kyphosis was observed, with similar correction rates between the two groups (p = 0.380). However, correction loss was slightly but significantly less in the low-Risser group during follow-up (p < 0.001). The ratio between anterior vertebral body height (AVBH) and posterior vertebral body height (PVBH) of deformed vertebrae notably increased in SK patients from postoperation to latest follow-up (p < 0.05). Loss of correction of global kyphosis was significantly and negatively correlated with increased AVBH/PVBH ratio. Compared with the high-Risser group, the low-Risser group had significantly greater increase in AVBH/PVBH ratio during follow-up (p < 0.05). The two groups had similar preoperative and postoperative Scoliosis Research Society-22 questionnaire scores for all domains.
Obvious reversal in wedge deformation of vertebrae was observed in adolescent SK patients. Patients with substantial growth potential had greater vertebral remodeling and less correction loss. Structural remodeling of vertebral bodies has a positive effect and protects against correction loss. These results could be help guide treatment decision-making.
本研究旨在探讨青少年特发性脊柱后凸（SK）患者后路矫形后椎体楔变的逆转情况，并评估椎体重塑对矫正维持的作用。
对 SK 患者进行回顾性队列研究。共纳入 45 例手术时年龄为 10-20 岁的 SK 患者。所有患者均获得至少 24 个月的随访，且末次随访时 Risser 征≥4 级。术前 Risser 征 3 级或以下的患者被分配到低 Risser 组，而 Risser 征 4 级或 5 级的患者被分配到高 Risser 组。收集两组患者术前、术后即刻和末次随访时的影像学资料和患者报告的结局，并进行比较。
两组患者的整体后凸矫正均有明显改善，且矫正率相似（p = 0.380）。但在随访过程中，低 Risser 组的矫正丢失量略少，但差异有统计学意义（p < 0.001）。SK 患者术后到末次随访时，变形椎体的前椎体高度（AVBH）与后椎体高度（PVBH）的比值显著增加（p < 0.05）。整体后凸矫正丢失与 AVBH/PVBH 比值的增加呈显著负相关。与高 Risser 组相比，低 Risser 组在随访过程中 AVBH/PVBH 比值的增加显著更大（p < 0.05）。两组患者术前和术后 SRS-22 问卷所有领域的评分均相似。
青少年 SK 患者的椎体楔形变形明显逆转。具有较大生长潜能的患者具有更大的椎体重塑和更小的矫正丢失。椎体的结构性重塑具有积极作用，可防止矫正丢失。这些结果可能有助于指导治疗决策。
