Pediatric Orthopedics, CHU Timone, Aix MArseille University, Marseille, France.
Department of Pediatric Orthopedics and Scoliosis Surgery, Hôpitaux Pédiatriques de Nice Chu Lenval, 57 Avenue de la Californie, 06200, Nice, France.
Eur Spine J. 2022 Apr;31(4):1028-1035. doi: 10.1007/s00586-022-07145-7. Epub 2022 Feb 28.
When performing posterior spinal fusion for adolescent idiopathic scoliosis (AIS), it is of major importance to address both coronal and sagittal deformities. Although several techniques have been described, few data exist comparing them. Our objective was to compare four techniques (in situ bending (ISB), rod derotation (RD), cantilever (C) and posteromedial translation (PMT)) for the correction of spinal deformity in AIS including thoracic deformity.
We conducted a multicenter retrospective study including 562 AIS patients with thoracic deformity with at least 24-month follow-up. Radiographic analysis was performed preoperatively, postoperatively and at last follow-up. The main outcomes were main curve correction and thoracic kyphosis restoration (TK).
Coronal correction rate was significantly different among the four treatment groups (ISB 64% vs C 57% vs RD 55% vs PMT 67%, p < 0.001). Multivariate regression revealed that correction technique did not influence correction rate, whereas implant density, convex side compression and use of derotation connectors did. TK increase was significantly higher in the PMT group (average + 13°) than in DR (+ 3°), while ISB (-3°) and cantilever (-13°) resulted in TK decrease (p < 0.001). Multivariate analysis revealed that TK increase was only influenced by the reduction technique (p < 0.001) and preoperative TK (p < 0.001).
The four techniques had the same ability to correct spinal deformity in the coronal plane. Three factors were identified to improve correction rate: implant density, convex compression and use of derotation connectors. On the other hand, PMT was more effective in restoring TK, particularly in hypokyphotic patients.
在为青少年特发性脊柱侧凸（AIS）进行后路脊柱融合时，纠正冠状面和矢状面畸形至关重要。尽管已经描述了几种技术，但比较它们的数据很少。我们的目的是比较四种技术（原位弯曲（ISB）、棒旋转（RD）、悬臂（C）和后内侧平移（PMT））在 AIS 包括胸弯畸形中的脊柱畸形矫正效果。
我们进行了一项多中心回顾性研究，纳入了 562 例至少有 24 个月随访的伴有胸弯畸形的 AIS 患者。术前、术后和末次随访时进行影像学分析。主要结果是主弯矫正和胸椎后凸（TK）恢复。
四种治疗组的冠状面矫正率差异有统计学意义（ISB 64% vs C 57% vs RD 55% vs PMT 67%，p<0.001）。多变量回归显示，矫正技术并不影响矫正率，而植入物密度、凸侧加压和使用旋转连接器会影响矫正率。PMT 组的 TK 增加量显著更高（平均增加 13°），而 RD 组（增加 3°）、ISB 组（减少 3°）和悬臂组（减少 13°）则导致 TK 减少（p<0.001）。多变量分析显示，TK 增加仅受减压技术（p<0.001）和术前 TK（p<0.001）的影响。
四种技术在矫正冠状面脊柱畸形方面具有相同的能力。有三个因素被确定可以提高矫正率：植入物密度、凸侧加压和使用旋转连接器。另一方面，PMT 在恢复 TK 方面更有效，尤其是在胸椎后凸不足的患者中。
