Department of Pediatric Orthopaedics, Cohen Children's Medical Center, New Hyde Park, NY.
New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY.
Spine (Phila Pa 1976). 2022 Sep 15;47(18):1321-1327. doi: 10.1097/BRS.0000000000004378. Epub 2022 Jul 28.
A retrospective review.
The objective of this study was to determine whether fusing to touched vertebra (TV) on prone x-rays (XRs) with minimal rotation (Gd 0/1) allow for shorter fusion with optimal correction.
Previous studies have shown risk of "adding on" when TV is not selected as lowest instrumented vertebra (LIV). Fusion proximal to TV leads to suboptimal results but fusing to TV on standing XRs can result in longer fusions. On lying down XRs, TV moves proximally, and its rotation decreases by a grade.
TV patients with minimal rotation were selected on prone (TVP) or standing XRs (TVS). Patients fused to rotated (Gd 2+) TV on standing or prone XRs were considered touched vertebra rotated (TVR). In the non-TV (NTV) group, LIV was fused proximal to TV. Disk wedging ≥5° determined risk of "adding-on." To compare patients fused to minimally rotated TV, to those that were not, patients in group A (TVP + TVS) were compared with group B (TVR + NTV).In part II: TVP, TVS, TVR, and NTV patients were compared. Subanalysis compared levels saved as the difference between predicted and real LIV in TVP and TVS patients. Another subanalysis was carried out for Lenke 1+2 and Lenke 3, 4, 5.In part III: XRs of nonoperative adolescents idiopathic scoliosis patients with Cobb <30 and Risser 4/5 were analyzed to determine "acceptable" end vertebra tilt and disc wedging and served as controls.
There were a significantly greater number of patients in group B patients(TVR + NTV) with final disk wedging ≥5°, final LIV translation ≥1 and ≥2 cm ( P <0.001).Utilizing prone XRs in TVP saved average 1 level, and 1.2 levels in TVS patients. TVP patients also had similar LIV tilt, disk wedging and coronal balance( P >0.05) to controls.
Choosing minimally rotated (Gd 0/1) TV on prone XR saves levels without sacrificing radiographic outcomes.
回顾性研究。
本研究的目的是确定在最小旋转（Gd0/1）下融合触诊椎（TV）是否允许更短的融合和最佳矫正。
先前的研究表明，当未选择 TV 作为最低置钉椎（LIV）时，存在“附加”的风险。在 TV 近端融合会导致结果不理想，但在站立位 X 光片上融合 TV 会导致融合更长。在卧位 X 光片上，TV 向近端移动，其旋转减少一级。
选择最小旋转的 TV 患者在俯卧位（TVP）或站立位（TVS）进行 X 光检查。在站立或俯卧位 X 光片上融合旋转（Gd2+）TV 的患者被认为是触诊椎旋转（TVR）。在非 TV（NTV）组中，LIV 融合在 TV 近端。椎间盘楔形≥5°确定了“附加”的风险。为了比较融合到最小旋转 TV 的患者与未融合的患者，将 A 组（TVP+TVS）患者与 B 组（TVR+NTV）患者进行比较。在第二部分：对 TVP、TVS、TVR 和 NTV 患者进行比较。亚分析比较了预测和实际 LIV 之间的差异，以确定 TVP 和 TVS 患者中节省的水平。另一个亚分析是针对 Lenke1+2 和 Lenke3、4、5 进行的。在第三部分：对 Cobb<30 和 Risser4/5 的非手术青少年特发性脊柱侧凸患者的 X 光片进行分析，以确定“可接受”的终末椎倾斜和椎间盘楔形，并作为对照组。
B 组（TVR+NTV）患者终末椎间盘楔形≥5°、终末 LIV 平移≥1 和≥2cm 的患者数量明显较多（P<0.001）。在 TVP 中使用俯卧位 X 光片可平均节省 1 个水平，在 TVS 患者中可节省 1.2 个水平。TVP 患者的 LIV 倾斜、椎间盘楔形和冠状平衡与对照组相似（P>0.05）。
在俯卧位 X 光片上选择最小旋转（Gd0/1）的 TV 可节省水平，而不会牺牲影像学结果。
