Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, People's Republic of China.
BMC Musculoskelet Disord. 2022 Aug 13;23(1):775. doi: 10.1186/s12891-022-05732-9.
The treatment of severe and rigid scoliosis is challenging. We developed a surgical strategy for severe and rigid scoliosis since 2014. This study aimed to retrospectively analyze the safety and efficacy of apical region correction and global balance with 3 rods as a surgical strategy for the treatment of severe and rigid scoliosis.
A retrospective study was performed for patients with severe and rigid scoliosis who underwent one-stage posterior corrective operation using the apical region correction and global balance with 3 rods surgical strategy between February 2014 and April 2020. The inclusion criteria were as follows: [1] Cobb angle > 90°; [2] flexibility < 30%; [3] a minimum 2-year follow-up. Patients were excluded if they had a history of traction or spinal surgery. Coronal and sagittal parameters, including Cobb angle, flexibility, apex vertebra translation, trunk shift (TS), thoracic kyphosis, lumbar lordosis, and sagittal vertical axis (SVA) were measured preoperatively, postoperatively and at the final follow-up. The Scoliosis Research Society 22-item questionnaire was administered preoperatively and at the final follow-up. During the operation, one slightly-bent short rod was placed into the concave side of apical region and correction was achieved by rod-rotation and distraction. Two pre-bent long rods were placed into both sides of the scoliosis and global balance was improved by leveling the proximal thoracic vertebrae and distal lumbar vertebrae.
A total of 41 patients were included, with an average age of 20 years (range, 12-49 years) and follow-up of 34 months (range, 24-58 months). Postoperative correction rate was 53% for scoliosis. There were 14 patients with normal kyphosis before surgery, and 28 patients with normal kyphosis at the last follow-up. 88% of the patients (23/26) with preoperative coronal imbalance (TS > 20 mm) restored coronal balance at the final follow-up. 87% of the patients (14/16) with preoperative sagittal imbalance (SVA > 40 mm) restored sagittal balance at the final follow-up. The mean operation time and blood loss were 286 min and 941 mL, respectively. No patients had neurological complications or implant failure.
The surgical strategy of apical region correction and global balance with 3 rods is a safe and effective alternative for the surgical treatment of severe and rigid scoliosis.
严重僵硬性脊柱侧弯的治疗具有挑战性。自 2014 年以来，我们制定了一种治疗严重僵硬性脊柱侧弯的手术策略。本研究旨在回顾性分析 3 棒顶椎区矫正和整体平衡在治疗严重僵硬性脊柱侧弯中的安全性和有效性。
对 2014 年 2 月至 2020 年 4 月间采用 3 棒顶椎区矫正和整体平衡手术策略进行一期后路矫正手术的严重僵硬性脊柱侧弯患者进行回顾性研究。纳入标准如下：[1] Cobb 角＞90°；[2]柔韧性＜30%；[3]至少 2 年随访。如果患者有牵引或脊柱手术史，则排除在外。术前、术后及末次随访时测量冠状位和矢状位参数，包括 Cobb 角、柔韧性、顶椎椎体平移、躯干偏移（TS）、胸椎后凸、腰椎前凸和矢状垂直轴（SVA）。术前和末次随访时进行脊柱侧凸研究协会 22 项问卷。术中在顶椎区凹侧放置一根稍弯短棒，通过棒旋转和牵伸达到矫正目的。在脊柱侧弯的两侧放置两根预弯长棒，通过水平近端胸椎和远端腰椎来改善整体平衡。
共纳入 41 例患者，平均年龄 20 岁（12-49 岁），随访 34 个月（24-58 个月）。脊柱侧弯术后矫正率为 53%。术前有 14 例患者胸椎后凸正常，末次随访时 28 例患者胸椎后凸正常。术前冠状面失衡（TS＞20mm）的 26 例患者中有 88%（23 例）在末次随访时恢复了冠状面平衡。术前矢状面失衡（SVA＞40mm）的 16 例患者中有 87%（14 例）在末次随访时恢复了矢状面平衡。手术时间和出血量分别为 286min 和 941mL。无患者发生神经并发症或内植物失败。
3 棒顶椎区矫正和整体平衡的手术策略是治疗严重僵硬性脊柱侧弯的一种安全有效的选择。
