Okubo Toshiki, Konomi Tsunehiko, Yanai Yoshihide, Kobayashi Yoshiomi, Furukawa Mitsuru, Fujiyoshi Kanehiro, Asazuma Takashi, Yato Yoshiyuki
Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, 2-37-1 Gakuen, Musahimurayama, Tokyo, Japan.
N Am Spine Soc J. 2023 Feb 23;14:100203. doi: 10.1016/j.xnsj.2023.100203. eCollection 2023 Jun.
No study has assessed the incidence or predictors of postoperative shoulder imbalance (PSI) in patients with Lenke type 5C adolescent idiopathic scoliosis (AIS) who underwent selective anterior spinal fusion (ASF). This study evaluated the incidence and predictors of shoulder imbalance after selective ASF for Lenke type 5C AIS.
In total, 62 patients with Lenke type 5C AIS (4 men and 58 women, mean age at surgery of 15.5 ± 1.5 years) were included and divided into the following two groups according to the radiographic shoulder height (RSH) at the final follow-up: PSI and non-PSI groups. All patients in this study underwent a whole-spine radiological evaluation. Various spinal coronal and sagittal profiles on radiographs were compared between the 2 groups. The clinical outcomes were assessed using the Scoliosis Research Society (SRS)-22 questionnaires.
The mean final follow-up duration was 8.6 ± 2.7 years. PSI was observed in 10 patients (16.1%) immediately after surgery; however, in the long-term follow-up period, PSI improved in 3 patients spontaneously, whereas the remaining 7 patients had residual PSI. The preoperative RSH and correction rates of the major curve immediately after surgery or at the final follow-up were significantly larger in the PSI group than in the non-PSI group (p=.001, p=.023, and p=.019, respectively). Receiver operating characteristic curve analysis indicated that the cutoff values for preoperative RSH and the correction rates immediately after surgery and at the final follow-up were 11.79 mm (p=.002; area under the curve [AUC], 0.948), 71.0% (p=.026; AUC, 0.822), and 65.4% (p=.021; AUC, 0.835), respectively. No statistically significant difference was observed in the preoperative and final follow-up SRS-22 scores in any domain between the PSI and non-PSI groups.
Paying attention to the preoperative RSH and avoiding excessive correction of the major curve can prevent the occurrence of shoulder imbalance after selective ASF for Lenke type 5C AIS.
尚无研究评估接受选择性前路脊柱融合术（ASF）的Lenke 5C型青少年特发性脊柱侧凸（AIS）患者术后肩部失衡（PSI）的发生率或预测因素。本研究评估了Lenke 5C型AIS患者选择性ASF术后肩部失衡的发生率及预测因素。
共纳入62例Lenke 5C型AIS患者（4例男性，58例女性，手术时平均年龄15.5±1.5岁），并根据末次随访时的影像学肩部高度（RSH）分为以下两组：PSI组和非PSI组。本研究中的所有患者均接受了全脊柱影像学评估。比较两组患者X线片上不同的脊柱冠状面和矢状面形态。使用脊柱侧凸研究学会（SRS）-22问卷评估临床结局。
平均末次随访时间为8.6±2.7年。术后即刻有10例患者（16.1%）出现PSI；然而，在长期随访期间，3例患者的PSI自发改善，而其余7例患者仍有残余PSI。PSI组术前RSH以及术后即刻或末次随访时主弯的矫正率均显著高于非PSI组（分别为p = 0.001、p = 0.023和p = 0.019）。受试者工作特征曲线分析表明，术前RSH以及术后即刻和末次随访时矫正率的截断值分别为11.79 mm（p = 0.002；曲线下面积[AUC]，0.948）、71.0%（p = 0.026；AUC，0.822）和65.4%（p = 0.021；AUC，0.835）。PSI组和非PSI组在任何领域的术前和末次随访SRS-22评分均无统计学显著差异。
关注术前RSH并避免主弯过度矫正可预防Lenke 5C型AIS患者选择性ASF术后肩部失衡的发生。
