Yang Yang, Su Zhe, Wang Shengru, Du You, Zhao Yiwei, Lin Guanfeng, Ye Xiaohan, Wu Nan, Zhuang Qianyu, Zhang Terry Jianguo
1Department of Orthopedics, Peking Union Medical College Hospital & Chinese Academy of Medical Science, Beijing, China and.
2Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Science, Beijing, China.
J Neurosurg Pediatr. 2023 Feb 3;31(4):358-368. doi: 10.3171/2022.12.PEDS22383. Print 2023 Apr 1.
Limited control of an apical deformity is a major disadvantage in the traditional dual growing rod (TDGR) technique. Previous literature has reported the results of apical pedicle screw placement (APS) as an apical control technique in patients with early-onset scoliosis (EOS). However, the clinical outcomes, indications, and complications of the TDGR technique combined with APSs have not been well described. The purpose of this study was to evaluate the preliminary clinical outcomes of the TDGR technique combined with APSs in EOS patients.
Clinical data of 12 patients with EOS who were treated with the TDGR technique combined with APSs at the index surgery at the authors' center from January 2010 to January 2020, with a minimum 2-year follow-up, were retrospectively reviewed. Indications for the use of APSs included 1) no vertebral segmentation failure, fused ribs, or multiple hemivertebrae at the apex; 2) at least 2 normal discs around the apex; and 3) proper development of apical pedicles on the convex side. Etiology, age at index surgery, number of lengthening procedures, follow-up duration, and complications were recorded. Radiographic measurements included Cobb angle, apical vertebral translation (AVT), apical vertebral rotation (AVR), thoracic kyphosis, lumbar lordosis, spine height, and space available for the lung (SAL).
The mean follow-up period was 4.0 ± 1.4 years, with a mean of 4.8 lengthening procedures per patient. The mean Cobb angle improved from 61.7° ± 10.4° to 19.9° ± 9.0° after the index surgery (19.6° ± 9.4° at the latest follow-up). The mean postindex AVT decreased to 16.8 ± 8.9 mm from a preindex AVT of 56.3 ± 9.7 mm and further improved to 13.6 ± 10.0 mm at the latest follow-up. The mean annual increases in T1-12 and T1-S1 height were 9.0 ± 4.7 mm and 13.9 ± 6.5 mm, respectively. The SAL improved from 0.91 to 1.04 at the latest follow-up. AVR improved significantly after the index surgery (p = 0.013), while minor deterioration was observed after repeat lengthening procedures. Five complications (2 implant related and 3 alignment related) occurred in 4 patients.
For EOS patients with good flexibility (without segmentation failure or multiple hemivertebrae at the apex), the TDGR technique combined with APSs can improve primary curve correction, maintain good correction results, and allow continuous spine growth, which may reduce the risks of complications during lengthening treatment. More multicenter prospective studies with larger samples are needed to further validate the findings of this study.
在传统双生长棒（TDGR）技术中，对顶椎畸形的控制有限是一个主要缺点。先前的文献报道了顶椎椎弓根螺钉置入术（APS）作为早发性脊柱侧凸（EOS）患者顶椎控制技术的结果。然而，TDGR技术联合APS的临床结果、适应证及并发症尚未得到充分描述。本研究的目的是评估TDGR技术联合APS在EOS患者中的初步临床结果。
回顾性分析2010年1月至2020年1月在作者所在中心接受TDGR技术联合APS初次手术治疗且至少随访2年的12例EOS患者的临床资料。使用APS的适应证包括：1）顶椎处无椎体分节失败、肋骨融合或多个半椎体；2）顶椎周围至少有2个正常椎间盘；3）凸侧顶椎椎弓根发育良好。记录病因、初次手术年龄、延长手术次数、随访时间及并发症。影像学测量包括Cobb角、顶椎椎体平移（AVT）、顶椎椎体旋转（AVR）、胸椎后凸、腰椎前凸、脊柱高度及肺可用空间（SAL）。
平均随访时间为4.0±1.4年，每位患者平均进行4.8次延长手术。初次手术后，平均Cobb角从61.7°±10.4°改善至19.9°±9.0°（末次随访时为19.6°±9.4°）。初次手术前AVT为56.3±9.7mm，术后降至16.8±8.9mm，末次随访时进一步改善至13.6±10.0mm。T1-12和T1-S1高度的年均增加量分别为9.0±4.7mm和13.9±6.5mm。末次随访时SAL从0.91改善至1.04。初次手术后AVR显著改善（p = 0.013），而在重复延长手术后观察到轻微恶化。4例患者发生5种并发症（2种与植入物相关，3种与对线相关）。
对于柔韧性良好（顶椎处无分节失败或多个半椎体）的EOS患者，TDGR技术联合APS可改善主弯矫正，维持良好的矫正效果，并允许脊柱持续生长，这可能降低延长治疗期间的并发症风险。需要更多多中心、大样本的前瞻性研究来进一步验证本研究结果。
