1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka.
2Department of Orthopaedic Surgery, Shinshu University, Matsumoto, Nagano.
J Neurosurg Spine. 2022 Jul 15;37(6):883-892. doi: 10.3171/2022.5.SPINE22385. Print 2022 Dec 1.
Persistent coronal imbalance (PCI) can develop postoperatively. In this study, the authors aimed to clarify the risk factors and clinical impact of PCI after posterior spinal fusion (PSF) in idiopathic scoliosis (IS) patients with a major thoracolumbar/lumbar (TL/L) curve.
Data on 108 patients with Lenke type 5C or 6C IS who underwent PSF with a minimum of 2 years of follow-up were retrospectively analyzed. PCI was defined as coronal imbalance persisting 2 years after surgery. Radiographic parameters and clinical outcomes were compared between the PCI (+) and PCI (-) groups. Multivariate regression analyses of associated factors were performed to determine the risk factors for PCI.
Of the 108 patients, 48 (44%) had immediate postoperative coronal imbalance, and 10 of these patients (9%) had coronal imbalance persisting 2 years after surgery. The PCI (+) group had significantly worse postoperative subtotal and satisfaction scores than the PCI (-) group. Preoperative apical vertebral translation (AVT) of the TL/L curve (AVT-TL/L) and postoperative coronal balance (CB) were identified as independent risk factors for PCI. The cutoff values of preoperative AVT-TL/L at 49.5 mm (area under the curve [AUC] 0.835, p = 0.001, 95% CI 0.728-0.941, sensitivity 70.0%, specificity 72.4%) and those of postoperative CB at -27.5 mm (AUC 0.837, p < 0.001, 95% CI 0.729-0.945, sensitivity 78.6%, specificity 70.0%) were used to predict PCI. In selective fusion cases, older age (OR 2.110, 95% CI 1.159-3.842, p = 0.015), greater preoperative AVT-TL/L (OR 1.199, 95% CI 1.029-1.398, p = 0.020), and less postoperative CB (OR 0.855, 95% CI 0.743-0.983, p = 0.027) were independent risk factors for PCI.
Preoperative AVT-TL/L and postoperative CB are important parameters for predicting PCI. PCI adversely affects postoperative clinical outcomes. In selective fusion surgery, PCI tends to occur in older patients due to reduced flexibility and compensatory abilities.
术后可能会出现持续性冠状面失衡（PCI）。本研究旨在明确胸腰段/腰椎（TL/L）大曲线特发性脊柱侧凸（IS）患者后路脊柱融合（PSF）后 PCI 的危险因素和临床影响。
回顾性分析了 108 例 Lenke 型 5C 或 6C IS 患者的资料，这些患者均接受了至少 2 年随访的 PSF。将术后 2 年仍存在冠状面失衡定义为 PCI。比较 PCI（+）组和 PCI（-）组的影像学参数和临床结果。采用多变量回归分析相关因素，确定 PCI 的危险因素。
108 例患者中，48 例（44%）术后即刻存在冠状面失衡，其中 10 例（9%）患者术后 2 年仍存在冠状面失衡。与 PCI（-）组相比，PCI（+）组的术后总满意度评分和部分满意度评分明显较差。TL/L 曲线上的术前顶椎椎体平移（AVT）（AVT-TL/L）和术后冠状面平衡（CB）是 PCI 的独立危险因素。术前 AVT-TL/L 的临界值为 49.5mm（曲线下面积[AUC]0.835，p=0.001，95%CI 0.728-0.941，灵敏度 70.0%，特异性 72.4%）和术后 CB 的临界值为-27.5mm（AUC 0.837，p<0.001，95%CI 0.729-0.945，灵敏度 78.6%，特异性 70.0%），可用于预测 PCI。在选择性融合病例中，年龄较大（OR 2.110，95%CI 1.159-3.842，p=0.015）、术前 AVT-TL/L 较大（OR 1.199，95%CI 1.029-1.398，p=0.020）和术后 CB 较小（OR 0.855，95%CI 0.743-0.983，p=0.027）是 PCI 的独立危险因素。
术前 AVT-TL/L 和术后 CB 是预测 PCI 的重要参数。PCI 会对术后临床结果产生不利影响。在选择性融合手术中，由于灵活性和代偿能力降低， PCI 更倾向于发生在老年患者中。
