Haddad Alexander F, Scheer Justin K, Fury Marissa T, Smith Justin S, Deviren Vedat, Ames Christopher P
Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
Neurospine. 2021 Sep;18(3):515-523. doi: 10.14245/ns.2040576.288. Epub 2021 Sep 30.
Extension of the posterior upper-most instrumented vertebra (UIV) into the upper thoracic (UT) spine allows for greater deformity correction and reduced incidence of proximal junction kyphosis (PJK) in adult spinal deformity (ASD) patients. However, it may be associated with chronic postoperative scapular pain (POSP). The goal of this study was to assess the relationship between UT UIV and persistent POSP, describe the pain, and assess its impact on patient disability.
ASD patients who underwent multilevel posterior fusion were retrospectively identified then administered a survey regarding scapular pain and the Oswestry Disability Index (ODI), by telephone. Univariate and multivariate analysis were utilized.
A total of 74 ASD patients were included in the study: 37 patients with chronic POSP and 37 without scapular pain. The mean age was 70.5 years, and 63.9% were women. There were no significant differences in clinical characteristics, including mechanical complications (PJK, pseudarthrosis, and rod fracture) or reoperation between groups. Patients with persistent POSP were more likely to have a UT than a lower thoracic UIV (p = 0.018). UT UIV was independently associated with chronic POSP on multivariate analysis (p = 0.022). ODI score was significantly higher in patients with scapular pain (p = 0.001). Chronic POSP (p = 0.001) and prior spine surgery (p = 0.037) were independently associated with ODI on multivariate analysis.
A UT UIV is independently associated with increased odds of chronic POSP, and this pain is associated with significant increases in patient disability. It is a significant clinical problem despite solid radiographic fusion and the absence of PJK.
在成人脊柱畸形（ASD）患者中，将最上方的后路固定椎体（UIV）延伸至胸上段（UT）脊柱可实现更大程度的畸形矫正，并降低近端交界性后凸（PJK）的发生率。然而，这可能与术后慢性肩胛疼痛（POSP）相关。本研究的目的是评估UT UIV与持续性POSP之间的关系，描述疼痛情况，并评估其对患者残疾的影响。
对接受多节段后路融合术的ASD患者进行回顾性识别，然后通过电话对其进行关于肩胛疼痛和奥斯威斯利残疾指数（ODI）的调查。采用单因素和多因素分析。
本研究共纳入74例ASD患者：37例有慢性POSP，37例无肩胛疼痛。平均年龄为70.5岁，63.9%为女性。两组在临床特征方面无显著差异，包括机械并发症（PJK、假关节形成和棒材骨折）或再次手术情况。持续性POSP患者的UIV更有可能位于UT而非胸下段（p = 0.018）。多因素分析显示UT UIV与慢性POSP独立相关（p = 0.022）。有肩胛疼痛患者的ODI评分显著更高（p = 0.001）。多因素分析显示慢性POSP（p = 0.001）和既往脊柱手术（p = 0.037）与ODI独立相关。
UT UIV与慢性POSP发生率增加独立相关，且这种疼痛与患者残疾程度显著增加相关。尽管影像学融合良好且无PJK，但这仍是一个严重的临床问题。
