Department of Orthopedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan.
Spine (Phila Pa 1976). 2022 Feb 1;47(3):234-241. doi: 10.1097/BRS.0000000000004114.
Retrospective comparative study.
The aim of this study was to evaluate the changes in global spinal sagittal alignment (GSSA) following selective anterior spinal fusion (ASF) in patients with Lenke type 5 adolescent idiopathic scoliosis (AIS).
Few studies have assessed the changes in postoperative GSSA, including cervical, thoracic, and lumbosacral sagittal alignment in AIS patients with major thoracolumbar/lumbar (TL/L) curve who underwent selective ASF.
Fifty-two patients with Lenke type 5 AIS (two males and 50 females, mean age at surgery of 16.4 ± 3.1 years) were included in this study. The average final follow-up was 8.3 ± 3.1 years after surgery. The variations of outcome variables were analyzed in various spinal sagittal profiles using radiographic outcomes (pre-operation, immediate post-operation, and final follow-up). The clinical outcomes at the final follow-up were assessed using Scoliosis Research Society (SRS)-22 and Oswestry Disability Index (ODI) questionnaires.
The mean Cobb angle of the main TL/L and minor thoracic curve was significantly improved after selective ASF, which was maintained up to the final follow-up. However, in all cases, the various sagittal parameters examined (sagittal vertical axis [SVA], C2-7 SVA, C2-7 lordosis, T1 slope, thoracic kyphosis, T10-L2 kyphosis, lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope), did not significantly change in the immediate postoperative period, and all GSSA parameters were maintained up to the final follow-up. Furthermore, the magnitude of coronal curve correction and fused levels did not affect each GSSA parameter postoperatively. During the period up to the final follow-up, no significant clinical symptoms were observed. The final SRS-22 global score was 4.5 ± 0.3, and ODI scored 0.8 ± 2.4.
Selective ASF did not influence various GSSA parameters postoperatively and could maintain excellent correction for coronal deformity with satisfactory final functional and clinical outcomes confirmed by long-term follow-up.Level of Evidence: 4.
回顾性对比研究。
本研究旨在评估选择性前路脊柱融合术（ASF）治疗 Lenke 型 5 型青少年特发性脊柱侧凸（AIS）患者后，整体脊柱矢状面排列（GSSA）的变化。
少数研究评估了术后 GSSA 的变化，包括主要胸腰椎/腰椎（TL/L）曲线的 AIS 患者的颈椎、胸椎和腰骶段矢状面排列，这些患者接受了选择性 ASF。
本研究纳入了 52 例 Lenke 型 5 型 AIS 患者（2 名男性，50 名女性，手术时平均年龄为 16.4±3.1 岁）。术后平均最终随访时间为 8.3±3.1 年。使用放射学结果（术前、术后即刻和最终随访）分析各种脊柱矢状面参数的变化。最终随访时采用 SRS-22 和 Oswestry 残疾指数（ODI）问卷评估临床结果。
选择性 ASF 后主要 TL/L 和次要胸椎曲线的 Cobb 角显著改善，且一直维持到最终随访。然而，在所有病例中，检查的各种矢状面参数（矢状垂直轴[SVA]、C2-7 SVA、C2-7 前凸、T1 斜率、胸椎后凸、T10-L2 后凸、腰椎前凸、骨盆入射角、骨盆倾斜度和骶骨倾斜度）在术后即刻均未显著改变，所有 GSSA 参数一直维持到最终随访。此外，冠状弯曲矫正程度和融合节段数量对术后各 GSSA 参数没有影响。在最终随访期间，没有观察到明显的临床症状。最终 SRS-22 总体评分为 4.5±0.3，ODI 评分为 0.8±2.4。
选择性 ASF 术后不会影响各种 GSSA 参数，并且可以在长期随访中维持对冠状畸形的良好矫正，同时获得令人满意的最终功能和临床结果。
4 级。
