Department of Orthopaedic Surgery, University of California San Francisco, 505 Parnassus Ave MU 320W, San Francisco, CA, 94143, USA.
University of California San Francisco School of Medicine, San Francisco, CA, 94143, USA.
Spine Deform. 2023 Jul;11(4):919-925. doi: 10.1007/s43390-023-00661-6. Epub 2023 Feb 21.
While posterior spinal instrumentation and fusion (PSIF) for severe adolescent idiopathic scoliosis (AIS) is the gold standard, anterior vertebral body tethering (AVBT) is becoming an alternative for select cases. Several studies have compared technical outcomes for these two procedures, but no studies have compared post-operative pain and recovery.
In this prospective cohort, we evaluated patients who underwent AVBT or PSIF for AIS for a period of 6 weeks after operation. Pre-operative curve data were obtained from the medical record. Post-operative pain and recovery were evaluated with pain scores, pain confidence scores, PROMIS scores for pain behavior, interference, and mobility, and functional milestones of opiate use, independence in activities of daily living (ADLs), and sleeping.
The cohort included 9 patients who underwent AVBT and 22 who underwent PSIF, with a mean age of 13.7 years, 90% girls, and 77.4% white. The AVBT patients were younger (p = 0.03) and had fewer instrumented levels (p = 0.03). Results were significant for decreased pain scores at 2 and 6 weeks after operation (p = 0.004, and 0.030), decreased PROMIS pain behavior at all time points (p = 0.024, 0.049, and 0.001), decreased pain interference at 2 and 6 weeks post-operative (p = 0.012 and 0.009), increased PROMIS mobility scores at all time points (p = 0.036, 0.038, and 0.018), and faster time to functional milestones of weaning opiates, independence in ADLs, and sleep (p = 0.024, 0.049, and 0.001).
In this prospective cohort study, the early recovery period following AVBT for AIS is characterized by less pain, increased mobility, and faster recovery of functional milestones, compared with PSIF.
IV.
尽管后路脊柱内固定融合术（PSIF）是重度青少年特发性脊柱侧凸（AIS）的金标准，但前路椎体拴系术（AVBT）正成为某些病例的替代方法。有几项研究比较了这两种手术的技术结果，但没有研究比较术后疼痛和恢复情况。
在这项前瞻性队列研究中，我们评估了接受 AVBT 或 PSIF 治疗 AIS 的患者在手术后 6 周内的情况。术前曲线数据从病历中获得。术后疼痛和恢复情况采用疼痛评分、疼痛信心评分、PROMIS 疼痛行为、干扰和活动能力评分以及阿片类药物使用、日常生活活动（ADL）独立性和睡眠功能里程碑进行评估。
该队列包括 9 例接受 AVBT 治疗的患者和 22 例接受 PSIF 治疗的患者，平均年龄为 13.7 岁，90%为女性，77.4%为白人。AVBT 患者年龄更小（p=0.03），植入节段更少（p=0.03）。术后 2 周和 6 周时疼痛评分显著降低（p=0.004 和 0.030），所有时间点的 PROMIS 疼痛行为均显著降低（p=0.024、0.049 和 0.001），术后 2 周和 6 周时疼痛干扰显著降低（p=0.012 和 0.009），所有时间点的 PROMIS 活动能力评分均显著增加（p=0.036、0.038 和 0.018），且阿片类药物脱毒、ADL 独立性和睡眠功能里程碑的时间更快（p=0.024、0.049 和 0.001）。
在这项前瞻性队列研究中，与 PSIF 相比，AVBT 治疗 AIS 的早期恢复期疼痛较轻、活动能力更高、功能里程碑恢复更快。
IV。
