Department of Orthopaedics and Traumatology, Gazi University Medical Faculty, Ankara, Turkey.
Department of Orthopaedics and Traumatology, Antalya Education and Research Hospital, Health Sciences University, Antalya, Turkey.
Eur Spine J. 2023 Jun;32(6):2213-2220. doi: 10.1007/s00586-023-07669-6. Epub 2023 Apr 3.
There is still no consensus on the optimum pedicle screw density required for the desired thoracic kyphosis restoration in adolescent idiopathic surgery (AIS). The aim of this study to evaluate the effect of pedicle screw density on thoracic kyphosis restoration in AIS surgery.
The data of 106 patients from two centers that operated for Lenke type 1 and 2 AIS were retrospectively reviewed. Two groups were constituted according to the pedicle screw density: intermittent pedicle screw constructs (IPSC) (n = 52 patients) and consecutive pedicle screw construct (CPSC) (n = 54 patients) groups. The preoperative and at least 24-month follow-up radiographs and SRS-22 scores were evaluated. The Cobb angle of the main and concomitant curves in the coronal plane and the sagittal plane were measured and compared.
The mean follow-up period for the IPSC and CPSC groups was 72.3 ± 37.2 and 62.9 ± 28.8 months, respectively. In the SRS-22 questionnaire, there was no significant difference between the two groups in terms of self-image/appearance domain scores (p = 0.466), but better results were obtained in the IPSC group in terms of treatment satisfaction domain scores (p = 0.010) and better thoracic kyphosis restoration was achieved in IPSC group radiologically for Lenke type 1 curves with - 81.4 ± 81.4% in the IPSC group and 6.8 ± 83.8% in the CPSC group (p < 0.001).
It was considered that better thoracic kyphosis restoration could be achieved with the less lordotic effect of IPSC in Lenke type 1 curves. Although the current situation had a significant impact on radiological outcomes, its effect on SRS-22 scores was limited.
在青少年特发性脊柱侧凸（AIS）手术中，对于理想的胸椎后凸恢复所需的最佳椎弓根螺钉密度仍未达成共识。本研究旨在评估椎弓根螺钉密度对 AIS 手术中胸椎后凸恢复的影响。
回顾了来自两个中心的 106 例接受 Lenke 1 型和 2 型 AIS 手术患者的数据。根据椎弓根螺钉密度将患者分为两组：间断性椎弓根螺钉固定（IPSC）组（n=52 例）和连续性椎弓根螺钉固定（CPSC）组（n=54 例）。评估术前和至少 24 个月的随访 X 线片和 SRS-22 评分。测量并比较冠状面和矢状面主弯和伴弯的 Cobb 角。
IPSC 和 CPSC 组的平均随访时间分别为 72.3±37.2 和 62.9±28.8 个月。在 SRS-22 问卷中，两组在自我形象/外观领域评分方面没有显著差异（p=0.466），但 IPSC 组在治疗满意度领域评分方面结果更好（p=0.010），并且 IPSC 组在影像学上获得了更好的胸椎后凸恢复，在 IPSC 组中 Lenke 1 型曲线的矫正率为-81.4±81.4%，而在 CPSC 组中为 6.8±83.8%（p<0.001）。
认为 IPSC 具有较小的前凸效应，可在 Lenke 1 型曲线上获得更好的胸椎后凸恢复。虽然目前的情况对影像学结果有显著影响，但对 SRS-22 评分的影响有限。
