Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany.
Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany.
World Neurosurg. 2022 Sep;165:e352-e356. doi: 10.1016/j.wneu.2022.06.054. Epub 2022 Jun 16.
Most children with spinal muscular atrophy (SMA) develop spinal deformity, which may require surgical intervention. In addition to poor bone stock, vertebral body shape may hinder the placement of spinal implants resulting in complications and poor outcome. The aim of this study was to analyze whether vertebral body morphology of children and adolescents with SMA is altered in comparison to healthy age-matched controls.
In this prospective cohort study, 17 children with SMA (mean age 8.7 ±1.0 years) and 13 adolescents with SMA (mean age 13.6 ±1.4 years), all with some degree of neuromuscular scoliosis, were analyzed by standardized radiographic measurements to evaluate vertebral body height and depth. Results were compared with age-matched healthy controls (n = 10 children; mean age 9.1 ± 1.6 years; n = 20 adolescents, mean age 13.1 ± 0.5 years). Computed tomography scans of 27 adolescents with SMA (13.5 ±1.2 years) and 25 healthy age-matched controls (13.8 ±2.0 years) were analyzed to define pedicle diameters.
All children and adolescents with SMA had decreased vertebral height and depth in comparison to age-matched healthy controls. In adolescents, reduced depth was more pronounced than height in the thoracic spine. Pedicle size was significantly reduced in the lower thoracic and lumbar area.
Reduced vertebral body height and depth and pedicle size in children and adolescents with SMA may influence surgical treatment of spinal deformity. Surgeons should be aware of anatomical differences and choose implant devices accordingly.
大多数脊髓性肌萎缩症（SMA）患儿会出现脊柱畸形，可能需要手术干预。除了骨质不佳外，椎体形状也可能妨碍脊柱植入物的放置，导致并发症和不良结果。本研究旨在分析 SMA 患儿和青少年的椎体形态是否与健康同龄对照组存在差异。
在这项前瞻性队列研究中，分析了 17 名 SMA 患儿（平均年龄 8.7 ±1.0 岁）和 13 名 SMA 青少年（平均年龄 13.6 ±1.4 岁），所有患者均存在不同程度的神经肌肉性脊柱侧凸，通过标准化的影像学测量评估椎体高度和深度。将结果与年龄匹配的健康对照组（n=10 名儿童；平均年龄 9.1 ±1.6 岁；n=20 名青少年，平均年龄 13.1 ±0.5 岁）进行比较。对 27 名 SMA 青少年（平均年龄 13.5 ±1.2 岁）和 25 名健康同龄对照组（平均年龄 13.8 ±2.0 岁）的 CT 扫描进行分析，以确定椎弓根直径。
与年龄匹配的健康对照组相比，所有 SMA 患儿和青少年的椎体高度和深度均降低。在青少年中，胸椎的椎体深度比高度降低更为明显。在胸腰段和腰椎下段，椎弓根尺寸明显减小。
SMA 患儿和青少年的椎体高度和深度以及椎弓根尺寸减小可能会影响脊柱畸形的手术治疗。外科医生应注意到这些解剖学差异，并相应地选择植入物装置。
