Berlin Clara, Quante Markus, Halm Henry
Spine Surgery with Scoliosis Center, Schön Klinik Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Germany.
Eur Spine J. 2023 Apr;32(4):1187-1195. doi: 10.1007/s00586-023-07617-4. Epub 2023 Mar 1.
PURPOSE: Adolescent idiopathic scoliosis (AIS) often correspond with hypo thoracic kyphosis (TK) or even lordosis. The aim of this study was to analyze the influence of posterior instrumentation in thoracic AIS. METHODS: Analysis of prospectively collected AIS-data with structural thoracic curves (Lenke type 1 & 2), operated 2010-2019 with pedicle screw dual rod systems in one scoliosis center. Follow-up (FU) minimum 24 months. Coronal and sagittal angles measured based on standing long-cassette-X-rays: thoracic major (MC), proximal thoracic (PC) and lumbar curve (LC), TK, lumbar lordosis (LL). STATISTICAL ANALYSIS: values as mean ± SD, differences by student's t-test (significancy a = 0.05), Pearson's correlation, sub-analysis with sagittal modifier (-, N, +). RESULTS: A total of 127 AIS could be identified (63% type 1, 37% type 2). Mean FU 32.2 ± 16.6 months, mean age 14 ± 1.5 years. Mean Correction of MC 73 ± 12%, PC 51 ± 17%, LC 69 ± 21% with a significantly better correction of PC in Lenke 2 curves(p < 0.05). On average, TK (FU-preop) decreased by -2.1 ± 12.1°(p < 0.05) in all AIS. Whereas TK in type 1 was unchanged (p = 0.9), TK significantly decreased by - 6.0 ± 12.7°(p < 0.05) in type 2. No significant difference in LL. TK in hypokyphotic cases increased by 9.5 ± 5.5°(p < 0.05), stayed almost unchanged (- 1.4 ± 9.1°,p = 0.2) in normokyphotic, decreased by - 17.2 ± 14.2°(p < 0.05) in hyperkyphotic cases. Only hypokyphotic cases had a moderately strong correlation between correction of LC (r = 0.6) and PC (r = - 0.4) (frontal plane) and change from pre- to postoperative TK (sagittal plane) (r = 0.6). No relevant correlations for normo- and hyperkyphotic AIS. Postoperative hypokyphosis was significantly more often in Lenke 2 (16.3% vs. 2.6%, p < 0.05). Rod diameter (5,5 mm versus 6 mm) had no significant influence. CONCLUSION: Significant correction of hypo- and hyperkyphosis can be achieved with posterior spinal fusion (pedicle screw dual rod systems), whereas normokyphotic spines stay unchanged. However, Lenke 2 curves have a significantly higher risk for a postoperative thoracic hypokyphosis.
目的：青少年特发性脊柱侧凸（AIS）常伴有胸椎后凸减小（TK）甚至脊柱前凸。本研究旨在分析后路内固定术对胸椎AIS的影响。 方法：对前瞻性收集的结构性胸椎侧弯（Lenke 1型和2型）AIS数据进行分析，2010 - 2019年在一个脊柱侧弯中心采用椎弓根螺钉双棒系统进行手术。随访（FU）至少24个月。基于站立位长盒式X线片测量冠状面和矢状面角度：胸椎主弯（MC）、胸椎近端弯（PC）和腰椎弯（LC）、TK、腰椎前凸（LL）。 统计分析：数据以平均值±标准差表示，采用学生t检验分析差异（显著性α = 0.05）、Pearson相关性分析，根据矢状面修正值（ - 、N、 + ）进行亚组分析。 结果：共识别出127例AIS患者（63%为1型，37%为2型）。平均随访32.2±16.6个月，平均年龄14±1.5岁。MC平均矫正73±12%，PC平均矫正51±17%，LC平均矫正69±21%，Lenke 2型曲线的PC矫正明显更好（p < 0.05）。所有AIS患者中，TK（随访 - 术前）平均下降 - 2.1±12.1°（p < 0.05）。1型患者的TK无变化（p = 0.9），2型患者的TK显著下降 - 6.0±12.7°（p < 0.05）。LL无显著差异。后凸减小的病例中TK增加9.5±5.5°（p < 0.05），正常后凸病例中TK几乎无变化（ - 1.4±9.°，p = 0.2），后凸增加的病例中TK下降 - 17.2±14.2°（p < 0.05）。只有后凸减小的病例在LC矫正（r = 0.6）与PC矫正（r = - 0.4）（冠状面）以及术前至术后TK变化（矢状面）（r = 0.6）之间存在中度强相关性。正常和后凸增加的AIS患者无相关相关性。Lenke 2型术后出现后凸减小的情况明显更常见（16.3% vs. 2.6%，p < 0.05）。棒直径（5.5mm与6mm）无显著影响。 结论：后路脊柱融合术（椎弓根螺钉双棒系统）可显著矫正后凸减小和后凸增加，而正常后凸的脊柱保持不变。然而，Lenke 2型曲线术后出现胸椎后凸减小的风险明显更高。
Ann Transl Med. 2020-1
Nat Rev Dis Primers. 2015-9-24
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