Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
J Bone Joint Surg Am. 2023 Feb 15;105(4):277-285. doi: 10.2106/JBJS.22.00939. Epub 2023 Jan 23.
Adolescent idiopathic scoliosis (AIS) curves of 50° to 75° are inclined to progress and are thus indicated for surgery. Nevertheless, the natural history of curves of 40° to 50° following skeletal maturity remains uncertain and presents a clinical dilemma. The aim of this study was to determine the prevalence, rate, and prognostic indicators of curve progression within this patient group.
This was a retrospective study of 73 skeletally mature patients with AIS. Following yearly or more frequent follow-up, patients were stratified as having no progression (<5° increase) or progression (≥5° increase). Those with progression were further differentiated as having standard progression (<2° increase/year) or fast progression (≥2° increase/year). Radiographic parameters (coronal balance, sagittal balance, truncal shift, apical translation, T1 tilt, apical vertebral wedging) and height were determined on skeletal maturity. Parameters that were significantly associated with progression were subject to receiver operating characteristic (ROC) curve analysis.
The average period of post-maturity follow-up was 11.8 years. The prevalence of progression was 61.6%. Among those with progression, the curve increased by a mean of 1.47° ± 1.22° per year, and among those with fast progression, by 3.0° ± 1.2° per year. Thoracic apical vertebral wedging (concave/convex vertebral height × 100) was more apparent in those with progression than in those without progression (84.1 ± 7.5 versus 88.6 ± 3.1; p = 0.003). Increased coronal imbalance (C7 plumb line to central sacral vertebral line) differentiated those with fast progression from others (16.0 ± 11.0 versus 8.7 ± 7.7 mm; p = 0.007). An ROC curve of height-corrected coronal balance demonstrated an area under the curve (AUC) of 0.722, sensitivity of 75.0%, and specificity of 72.5% in identifying fast progression. An ROC curve of height-corrected coronal balance together with apical vertebral wedging to identify those with progression demonstrated an AUC of 0.746, with specificity of 93.7% and sensitivity of 64.5%.
While the majority of curves progressed, the average rate of progression was slow, and thus, yearly observation was a reasonable management approach. Upon validation in larger cohorts, apical wedging and coronal imbalance may identity patients suited for closer monitoring and early spinal fusion.
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
青少年特发性脊柱侧凸（AIS）的角度为 50°至 75°，倾向于进展，因此需要手术治疗。然而，骨骼成熟后角度为 40°至 50°的自然史仍不确定，这构成了临床难题。本研究旨在确定该患者群体中曲线进展的发生率、速率和预后指标。
这是一项回顾性研究，共纳入 73 名骨骼成熟的 AIS 患者。在每年或更频繁的随访后，将患者分为无进展（<5°增加）或进展（≥5°增加）。进展的患者进一步分为标准进展（<2°/年）或快速进展（≥2°/年）。在骨骼成熟时确定冠状平衡、矢状平衡、躯干移位、顶椎偏移、T1 倾斜、顶椎椎体楔形角等影像学参数和身高。对与进展显著相关的参数进行受试者工作特征（ROC）曲线分析。
平均随访时间为骨骼成熟后 11.8 年。进展的发生率为 61.6%。进展患者的曲线每年增加 1.47°±1.22°，快速进展患者的曲线每年增加 3.0°±1.2°。进展患者的胸椎顶椎椎体楔形角（凹/凸椎体高度×100）明显大于无进展患者（84.1±7.5 比 88.6±3.1；p=0.003）。冠状不平衡（C7 铅垂线到中矢状椎体线）的增加可区分快速进展患者与其他患者（16.0±11.0 比 8.7±7.7mm；p=0.007）。校正身高后的冠状平衡 ROC 曲线的曲线下面积（AUC）为 0.722，快速进展的敏感度为 75.0%，特异性为 72.5%。校正身高后的冠状平衡和顶椎楔形角 ROC 曲线可识别进展患者，AUC 为 0.746，特异性为 93.7%，敏感度为 64.5%。
尽管大多数曲线都有进展，但平均进展速度较慢，因此每年观察是一种合理的管理方法。在更大的队列中验证后，顶椎楔形角和冠状不平衡可能可以识别适合更密切监测和早期脊柱融合的患者。
预后 III 级。请参阅作者指南以获取完整的证据水平描述。
Zotero 插件