Fabricant Peter D, Pascual-Leone Nicolas, Gross Preston W, Retzky Julia S, Green Daniel W, Blanco John S, Widmann Roger F
Hospital for Special Surgery, New York, NY.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Spine (Phila Pa 1976). 2023 Jun 1;48(11):737-741. doi: 10.1097/BRS.0000000000004599. Epub 2023 Feb 8.
Prospective cohort.
To determine if distal spinal fusion level is associated with postoperative sport participation after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).
The concept of "saving a level" during PSF for AIS refers to minimizing the distal extent of lumbar fusion to theoretically allow for increased postoperative spinal mobility and a more predictable return to athletic activity, as well as minimizing the risk of degenerative disc disease. There are few prospective studies evaluating the correlation between distal fusion level and timing of return to sports.
Adolescent patients undergoing PSF for AIS between 2009 and 2019 were approached at their presurgical visit to participate in this prospective study. Participants were followed for a minimum of 2 years after surgery. Sports participation (classified by sport type and level of competitiveness) and radiographic data were collected at the initial visit. At each postoperative visit, it was noted whether patients returned to the same sport type and level of competitiveness.
After an a priori power calculation was performed, a total of 106 participants were included in the analysis with a mean age of 14 ± 2 years. Distal fusion levels ranged from T11 to L4. There was no significant association between distal fusion level and return to the same level of sports participation ( P = 0.192). Of the participants, 93% returned to sports with no significant differences by distal fusion level ( P = 0.081). Distal fusion level demonstrated no difference in return to preoperative sport ( P = 0.486) or return to the same type of sport ( P = 0.247).
This study found no association between distal fusion level and postoperative sports participation. Even though many patients may elect to change sports, nearly all patients returned to sports, and the majority of patients returned to the same level of sports competition or higher after PSF for AIS.
前瞻性队列研究。
确定青少年特发性脊柱侧凸（AIS）后路脊柱融合术（PSF）后，脊柱远端融合节段与术后运动参与情况是否相关。
AIS的PSF术中“保留一个节段”的概念是指尽量缩短腰椎融合的远端范围，理论上可增加术后脊柱活动度，更可预测地恢复体育活动，并降低椎间盘退变疾病的风险。很少有前瞻性研究评估远端融合节段与恢复运动时间之间的相关性。
对2009年至2019年间接受AIS的PSF手术的青少年患者，在术前访视时邀请他们参加这项前瞻性研究。参与者术后至少随访2年。在初次访视时收集运动参与情况（按运动类型和竞争水平分类）和影像学数据。在每次术后访视时，记录患者是否恢复到相同的运动类型和竞争水平。
在进行先验效能计算后，共106名参与者纳入分析，平均年龄为14±2岁。远端融合节段范围为T11至L4。远端融合节段与恢复到相同运动参与水平之间无显著相关性（P = 0.192）。在参与者中，93%恢复运动，不同远端融合节段之间无显著差异（P = 0.081）。远端融合节段在恢复术前运动（P = 0.486）或恢复相同类型运动（P = 0.247）方面无差异。
本研究发现远端融合节段与术后运动参与情况之间无关联。尽管许多患者可能选择更换运动项目，但几乎所有患者都恢复了运动，并且大多数患者在AIS的PSF术后恢复到相同或更高水平的体育比赛。
