Spine Center, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, People's Republic of China.
Eur Spine J. 2022 Apr;31(4):996-1005. doi: 10.1007/s00586-021-07040-7. Epub 2021 Nov 6.
To introduce and evaluate our lowest instrumented vertebra (LIV) selection criteria for Lenke type 5/6 adolescent idiopathic scoliosis (AIS) patients with de-rotation technique.
There were 53 eligible Lenke 5/6 AIS patients with minimum 2-year follow-up enrolled in current study. The LIV selection criteria were: (1) the first vertebra touching the central sacral vertical line (CSVL) or the most cephalad vertebra which can return to stable zone under lateral bending position; (2) vertebral rotation no more than grade II by Nash-Moe rotation evaluation; (3) the lowest instrumented vertebra disc angle (LIVDA) could be reversed on lateral bending position. Demographic data, operation data and radiographic data were obtained and analyzed.
Both clinical evaluation and radiographic data showed satisfactory outcome. The thoracolumbar/lumbar curve was improved from 53.4 ± 11.0° preoperatively to 6.9 ± 2.6° at the final follow-up. Two patients (3.8%) with adding on and two patients (3.8%) with coronal decompensation were identified at the final follow-up. LIV translation, LIV tilt and LIV disc angle were gradually improved after operation. The preoperative LIV tilt was positively correlated with Cobb angle (p = 0.010) and AVT (p = 0.030) at the final follow-up, and preoperative LIVDA was positively correlated with Cobb angle (p = 0.033) at the final follow-up.
In Lenke 5/6 scoliosis, the current LIV selection criteria with de-rotation technique contribute to satisfactory correction rate of 87.1% and minimal alignment complications of 7.6%. LIV could be spontaneously and progressively improved after operation. Preoperative LIV tilt and LIVDA could predict postoperative correction and coronal balance.
介绍并评估我们用于 Lenke 型 5/6 青少年特发性脊柱侧凸（AIS）患者的最低置钉节段（LIV）选择标准，该标准结合了去旋转技术。
本研究共纳入 53 例符合条件的 Lenke 5/6 AIS 患者，所有患者均获得至少 2 年的随访。LIV 选择标准如下：（1）与 CSA 垂线（CSVL）接触的第一椎体或在侧位弯曲时能回到稳定区的最头端椎体；（2）Nash-Moe 旋转评估分级为 II 级或以下的椎体旋转；（3）LIV 椎间盘角度（LIVDA）在侧位弯曲时可以逆转。收集并分析患者的人口统计学数据、手术数据和影像学数据。
临床评估和影像学数据均显示出满意的结果。术前胸腰椎/腰椎曲线为 53.4°±11.0°，末次随访时改善为 6.9°±2.6°。在末次随访时，有 2 例（3.8%）患者出现附加矫正，2 例（3.8%）患者出现冠状面失代偿。术后 LIV 平移、LIV 倾斜和 LIV 椎间盘角度逐渐改善。术后 LIV 倾斜与 Cobb 角（p=0.010）和 AVT（p=0.030）呈正相关，术前 LIVDA 与 Cobb 角（p=0.033）呈正相关。
在 Lenke 5/6 型脊柱侧凸中，目前采用去旋转技术的 LIV 选择标准可获得 87.1%的满意矫正率和 7.6%的最小对线并发症。术后 LIV 可自发且逐渐改善。术前 LIV 倾斜和 LIVDA 可预测术后矫正和冠状平衡。
