Yamada Katsuhisa, Sudo Hideki, Abe Yuichiro, Kokabu Terufumi, Tachi Hiroyuki, Endo Tsutomu, Ohnishi Takashi, Ukeba Daisuke, Ura Katsuro, Takahata Masahiko, Iwasaki Norimasa
Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo 060-8638, Japan.
Department of Advanced Medicine for Spine and Spinal Cord Disorders, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan.
J Clin Med. 2023 Feb 9;12(4):1389. doi: 10.3390/jcm12041389.
This study aimed to evaluate the lowest instrumented vertebra translation (LIV-T) in the surgical treatment of thoracolumbar/lumbar adolescent idiopathic scoliosis and to analyze the radiographic parameters in relation to LIV-T and L4 tilt and global coronal balance. A total of 62 patients underwent posterior spinal fusion (PSF, = 32) or anterior spinal fusion (ASF, = 30) and were followed up for a minimum of 2 years. The mean preoperative LIV-T was significantly larger in the ASF group than the PSF ( < 0.01), while the final LIV-T was equivalent. LIV-T at the final follow-up was significantly correlated with L4 tilt and the global coronal balance (r = 0.69, < 0.01, r = 0.38, < 0.01, respectively). Receiver-operating characteristic analysis for good outcomes, with L4 tilt <8° and coronal balance <15 mm at the final follow-up, calculated the cutoff value of the final LIV-T as 12 mm. The cutoff value of preoperative LIV-T that would result in the LIV-T of ≤12 mm at the final follow-up was 32 mm in PSF, although no significant cutoff value was calculated in ASF. ASF can centralize the LIV better than PSF with a shorter segment fusion, and could be useful in obtaining a good curve correction and global balance without fixation to L4 in cases with large preoperative LIV-T.
本研究旨在评估胸腰段/腰椎青少年特发性脊柱侧凸手术治疗中最低融合椎体平移（LIV-T）情况，并分析与LIV-T、L4倾斜度及整体冠状面平衡相关的影像学参数。共有62例患者接受了后路脊柱融合术（PSF，n = 32）或前路脊柱融合术（ASF，n = 30），并进行了至少2年的随访。ASF组术前平均LIV-T显著大于PSF组（P < 0.01），而最终LIV-T相当。末次随访时的LIV-T与L4倾斜度及整体冠状面平衡显著相关（r分别为0.69，P < 0.01；r为0.38，P < 0.01）。以末次随访时L4倾斜度<8°且冠状面平衡<15 mm为良好预后的受试者工作特征分析，计算出末次随访时LIV-T的截断值为12 mm。PSF组中，若要使末次随访时LIV-T≤12 mm，术前LIV-T的截断值为32 mm，而ASF组未计算出显著的截断值。与PSF相比，ASF能以更短的节段融合更好地使最低融合椎体居中，对于术前LIV-T较大的病例，在不固定至L4的情况下获得良好的曲线矫正和整体平衡可能有用。
