Mimura Tetsuhiko, Ikegami Shota, Kuraishi Shugo, Uehara Masashi, Oba Hiroki, Takizawa Takashi, Munakata Ryo, Hatakenaka Terue, Kamanaka Takayuki, Miyaoka Yoshinari, Koseki Michihiko, Takahashi Jun
1Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto; and.
2Faculty of Textile Science and Technology, Shinshu University, Nagano, Japan.
J Neurosurg Spine. 2022 Feb 25;37(2):213-221. doi: 10.3171/2022.1.SPINE211251. Print 2022 Aug 1.
In recent years, it has become possible to predict postoperative correction and residual deformity in adolescent idiopathic scoliosis (AIS) surgery based on the technique used and extent of fixation. However, the recommended degree of correction has not yet been established. In this study, the authors aimed to clarify the extent to which a residual postoperative deformity would be acceptable according to Scoliosis Research Society (SRS)-22r and satisfaction scores after AIS surgery.
Overall, 92 patients who underwent posterior spinal fusion for Lenke type 1 or 2 AIS were retrospectively included. The Patient Acceptable Symptom State (PASS) cutoff values for each SRS-22r domain were calculated using receiver operating characteristic (ROC) curves to obtain predictive values of treatment satisfaction 2 years after surgery. Multivariate logistic regression analysis was performed with deformity parameters and demographic data as explanatory variables, and achieving the PASS cutoff value of each SRS-22r domain and treatment satisfaction were objective variables. Cutoff values were calculated using ROC analysis.
The PASS cutoff values for SRS-22r domains were 3.69 (area under the ROC curve [AUC] 0.86) for self-image, 4.25 (AUC 0.82) for mental health, and 4.22 (AUC 0.82) for the subtotal. The residual main thoracic Cobb angle was not remarkably related to SRS-22r or treatment satisfaction. The residual thoracolumbar/lumbar (TL/L) Cobb angle was significantly associated with treatment satisfaction, with a cutoff value of 12.5° (AUC 0.75). The parameters of deformity that were significantly associated with achieving the PASS cutoff value for self-image were the TL/L Cobb angle and main thoracic apical vertebral translation, although their respective AUCs were < 0.7.
In patients with Lenke type 1 and 2 AIS, the residual postoperative TL/L Cobb angle was significantly associated with achieving the PASS cutoff values for self-image and treatment satisfaction. Satisfaction with treatment was more likely when the TL/L Cobb angle was ≤ 12.5°.
近年来，基于所采用的技术和固定范围来预测青少年特发性脊柱侧凸（AIS）手术的术后矫正情况及残留畸形已成为可能。然而，推荐的矫正程度尚未确定。在本研究中，作者旨在根据脊柱侧凸研究学会（SRS）-22r评分和AIS手术后的满意度评分，阐明术后残留畸形可接受的程度。
本研究回顾性纳入了92例行后路脊柱融合术治疗Lenke 1型或2型AIS的患者。使用受试者工作特征（ROC）曲线计算每个SRS-22r领域的患者可接受症状状态（PASS）临界值，以获得术后2年治疗满意度的预测值。以畸形参数和人口统计学数据作为解释变量进行多因素逻辑回归分析，将达到每个SRS-22r领域的PASS临界值和治疗满意度作为目标变量。使用ROC分析计算临界值。
SRS-22r领域的PASS临界值分别为：自我形象方面为3.69（ROC曲线下面积[AUC]为0.86），心理健康方面为4.25（AUC为0.82），总分方面为4.22（AUC为0.82）。残留的胸主弯Cobb角与SRS-22r评分或治疗满意度无显著相关性。残留的胸腰段/腰段（TL/L）Cobb角与治疗满意度显著相关，临界值为12.5°（AUC为0.75）。与达到自我形象PASS临界值显著相关的畸形参数是TL/L Cobb角和胸主弯顶椎平移，尽管它们各自的AUC均<0.7。
在Lenke 1型和2型AIS患者中，术后残留的TL/L Cobb角与达到自我形象和治疗满意度的PASS临界值显著相关。当TL/L Cobb角≤12.5°时，治疗满意度更高。
