Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan.
Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Spine Deform. 2023 Sep;11(5):1145-1156. doi: 10.1007/s43390-023-00692-z. Epub 2023 Apr 26.
Postoperative distal adding-on and distal junctional kyphosis are major distal junctional complications after selective thoracic fusion in patients with adolescent idiopathic scoliosis (AIS). This study aimed to investigate the incidence of distal adding-on and distal junctional kyphosis and evaluate the validity of our selection criteria for the lowest instrumented vertebra (LIV) in patients with Lenke type 1A and 2A AIS.
We retrospectively analyzed the data of patients with Lenke type 1A and 2A AIS, who underwent posterior fusion surgery. LIV selection included the followings: (1) stable vertebra on traction film, (2) disc space neutralization below the LIV on the side-bending film, and (3) lordotic disc below the LIV on the lateral film. Radiographic parameters and the revised 22-item Scoliosis Research Society Questionnaire (SRS-22r) were evaluated. The incidence of postoperative distal adding-on and distal junctional kyphosis was also investigated.
Ninety patients (83 women and 7 men; 64 with type 1A and 26 with type 2A) were included. After the operation, each curve and the SRS-22r of self-image, mental health, and subtotal domains were significantly improved. Distal adding-on occurred in three patients (3.3%, one in type 1A and two in type 2A) at 2 years postoperatively. No patients exhibited distal junctional kyphosis.
Our LIV selection criteria could reduce the incidence of postoperative distal adding-on and distal junctional kyphosis in patients with Lenke type 1A and 2A AIS.
Level IV.
在青少年特发性脊柱侧凸（AIS）患者中，选择性胸椎融合术后的远端附加和远端交界后凸是远端交界并发症的主要类型。本研究旨在调查 Lenke 1A 和 2A 型 AIS 患者中远端附加和远端交界后凸的发生率，并评估我们选择最低固定椎（LIV）的标准的有效性。
我们回顾性分析了接受后路融合手术的 Lenke 1A 和 2A 型 AIS 患者的数据。LIV 的选择标准包括：（1）牵引片上稳定的椎骨，（2）侧位片上 LIV 以下椎间盘间隙中性化，（3）侧位片上 LIV 以下的前凸椎间盘。评估了影像学参数和修订后的 22 项脊柱侧凸研究协会问卷（SRS-22r）。还调查了术后远端附加和远端交界后凸的发生率。
90 例患者（83 例女性和 7 例男性；64 例为 1A 型，26 例为 2A 型）纳入本研究。术后，每个曲线和 SRS-22r 的自我形象、心理健康和总分域均有显著改善。术后 2 年，有 3 例（3.3%，1A 型 1 例，2A 型 2 例）发生远端附加。无患者出现远端交界后凸。
我们的 LIV 选择标准可以降低 Lenke 1A 和 2A 型 AIS 患者术后远端附加和远端交界后凸的发生率。
IV 级。
