Bane Thomas, Luhmann Scott J
Department of Orthopaedic Surgery, Washington University School of Medicine, 1 Children's Place, Suite 4S60, St. Louis, MO, 63110, USA.
Spine Deform. 2023 May;11(3):657-664. doi: 10.1007/s43390-023-00650-9. Epub 2023 Feb 22.
Does differential correction of main thoracic curve (MTC) and instrumented LIV angulation based on lumbar modifiers affect radiographic outcomes, and can preoperative supine AP radiograph be used to guide correction for optimal final radiographic alignment.
Retrospective analysis of idiopathic scoliosis patients who underwent selective thoracic fusions (LIV T11-L1) for Lenke 1 and 2 curve patterns, < 18 years of age. 2-year minimum follow-up. Optimal outcome meant LIV + 1 of < 5 degrees disk-wedging and C7-CSVL < 2 cm. 82 patients met inclusion criteria (70% female), mean age 14.1 years.
24 patients were A modifier, 21 B modifier, and 37 C modifier. There were 52 optimal and 30 suboptimal outcomes. LIV was not associated with outcome (p = 0.08). For optimal outcomes, A modifiers' MTC improved 65%, B modifiers 65%, and C modifiers 59%. C modifiers' MTC correction was less than A modifiers (p = 0.03) but equivalent to B modifiers' (p = 0.10). A modifiers' LIV + 1 tilt improved 65%, B modifiers 64%, and C modifiers 56%. C modifiers' instrumented LIV angulation was greater than A modifiers' (p < 0.01) but equivalent to B modifiers' (p = 0.06). Preoperative supine LIV + 1 tilt was 16 in optimal outcomes and 15° in suboptimal outcomes. Instrumented LIV angulation was 9° for both. The correction between preoperative LIV + 1 tilt and instrumented LIV angulation was not significantly different between groups (p = 0.67).
Differential MTC and LIV tilt correction based on lumbar modifier may be a valid goal. Optimizing radiographic outcome by matching instrumented LIV angulation to preoperative supine LIV + 1 tilt could not be proven.
IV.
基于腰椎修正值对主胸弯（MTC）和置入节段下端椎（instrumented LIV）成角进行差异矫正是否会影响影像学结果，术前仰卧前后位X线片能否用于指导矫正以实现最佳的最终影像学对线。
对年龄小于18岁、因Lenke 1型和2型侧弯模式接受选择性胸椎融合术（置入节段下端椎T11 - L1）的特发性脊柱侧凸患者进行回顾性分析。至少随访2年。最佳结果定义为置入节段下端椎上方一个椎体的椎间盘楔形变小于5度且C7 - CSVL小于2厘米。82例患者符合纳入标准（70%为女性），平均年龄14.1岁。
24例为A类修正值，21例为B类修正值，37例为C类修正值。有52例获得最佳结果，30例为次优结果。置入节段下端椎与结果无关（p = 0.08）。对于最佳结果，A类修正值的主胸弯改善65%，B类修正值改善65%，C类修正值改善59%。C类修正值的主胸弯矫正小于A类修正值（p = 0.03）但与B类修正值相当（p = 0.10）。A类修正值的置入节段下端椎上方一个椎体倾斜改善65%，B类修正值改善64%，C类修正值改善56%。C类修正值的置入节段下端椎成角大于A类修正值（p < 0.01）但与B类修正值相当（p = 0.06）。最佳结果组术前仰卧位置入节段下端椎上方一个椎体倾斜为16度，次优结果组为15度。两组的置入节段下端椎成角均为9度。术前置入节段下端椎上方一个椎体倾斜与置入节段下端椎成角之间的矫正差异在组间无统计学意义（p = 0.67）。
基于腰椎修正值进行差异主胸弯和置入节段下端椎倾斜矫正可能是一个有效的目标。通过使置入节段下端椎成角与术前仰卧位置入节段下端椎上方一个椎体倾斜相匹配来优化影像学结果这一点未得到证实。
IV级。
