Deng Zhipeng, Wang Liang, Song Yueming, Wang Linnan, Yang Xi, Liu Limin, Wang Lei
J Neurosurg Spine. 2023 Mar 10:1-8. doi: 10.3171/2023.2.SPINE221312.
Previous studies have evaluated growth in spinal height immediately following surgical posterior correction of idiopathic scoliosis, yet have not reported on further spinal growth following surgery. The aims of this study were to investigate the characteristics of spinal growth after scoliosis surgery and determine whether they affect spinal alignment.
The study included 91 patients (mean age 13.93 years) who underwent spinal fusion using pedicle screws for the treatment of adolescent idiopathic scoliosis (AIS). The study population included 70 female and 21 male patients. The height of the spine (HOS), length of the spine (LOS), and spinal alignment parameters were measured on anteroposterior and lateral radiographs. A stepwise multiple linear regression analysis was used to examine the variables that affected HOS gain from growth. The patients were divided into two groups, the growth group and the nongrowth group, according to whether the HOS gain from growth exceeded 1 cm, to analyze the effect of spinal growth on its alignment.
The mean (± SD) HOS gain from growth was 0.88 ± 0.66 (range -0.46 to 3.21) cm, with 40.66% of patients exhibiting growth ≥ 1 cm. This increase was significantly related to young age, male sex, and a small Risser stage (sex: b = -0.532, p < 0.001, male = 1, female = 2; Risser stage: b = -0.185, p < 0.001; age: b = -0.125, p = 0.011; adjusted R2 = 0.442). The variation in LOS was similar to that of HOS. Thoracic kyphosis and upper instrumented vertebra-lowest instrumented vertebra Cobb angle were reduced in both groups, with a greater reduction observed in the growth group. Patients with an increase in HOS < 1 cm showed a larger lumbar lordosis and a greater tendency for the sagittal vertical axis (SVA) to shift backward and the pelvic tilt to decrease (anteverted pelvis) than in the growth group.
The spine still has growth potential after corrective fusion surgery for AIS, and 40.66% of the patients in this study continued to vertically grow by 1 cm or more. Unfortunately, the height changes cannot be accurately predicted by currently measured parameters. Changes in the sagittal alignment of the spine may affect the vertical growth increment.
以往研究评估了特发性脊柱侧弯后路手术矫正后脊柱高度的即刻增长情况，但未报道术后脊柱的进一步生长情况。本研究旨在探讨脊柱侧弯手术后脊柱生长的特征，并确定其是否影响脊柱排列。
本研究纳入了91例（平均年龄13.93岁）接受椎弓根螺钉脊柱融合术治疗青少年特发性脊柱侧弯（AIS）的患者。研究人群包括70例女性和21例男性患者。在前后位和侧位X线片上测量脊柱高度（HOS）、脊柱长度（LOS）和脊柱排列参数。采用逐步多元线性回归分析来检验影响生长导致的HOS增加的变量。根据生长导致的HOS增加是否超过1 cm，将患者分为生长组和非生长组，以分析脊柱生长对其排列的影响。
生长导致的HOS平均增加（±标准差）为0.88±0.66（范围-0.46至3.21）cm，40.66%的患者生长≥1 cm。这种增加与年轻、男性性别和较小的Risser分期显著相关（性别：b=-0.532，p<0.001，男性=1，女性=2；Risser分期：b=-0.185，p<0.001；年龄：b=-0.125，p=0.011；调整后R2=0.442）。LOS的变化与HOS相似。两组的胸椎后凸和上固定椎-下固定椎Cobb角均减小，生长组减小更明显。HOS增加<1 cm的患者与生长组相比，腰椎前凸更大，矢状垂直轴（SVA）向后移位的趋势更大，骨盆倾斜度减小（骨盆前倾）。
AIS矫正融合手术后脊柱仍有生长潜力，本研究中40.66%的患者继续垂直生长1 cm或更多。遗憾的是，目前测量的参数无法准确预测身高变化。脊柱矢状面排列的改变可能影响垂直生长增量。
