Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, 149 rue de Sevres, 75015, Paris, France.
Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France.
Eur Spine J. 2023 Jul;32(7):2550-2557. doi: 10.1007/s00586-023-07745-x. Epub 2023 May 3.
Posterior spinal fusion (PSF) at skeletal maturity is still the gold standard in children with neuromuscular scoliosis (NMS) who underwent fusionless surgery. The aim of this computed tomography (CT) study was to quantify the spontaneous bone fusion at the end of a lengthening program by minimally invasive fusionless bipolar fixation (MIFBF), that could avoid PSF.
NMS operated on with MIFBF from T1 to the pelvis and at final lengthening program were included. CT was performed at least five years postoperatively. The autofusion was classified as completely or not fused at the facets joint (on both coronal and sagittal plane, right and left side, from T1 to L5), and around the rods (axial plane, right and left side, from T5 to L5). Vertebral body heights were assessed.
Ten patients were included (10.7y ± 2 at initial surgery). Mean Cobb angle was 82 ± 20 preoperatively and 37 ± 13 at last follow-up. CT were performed on average 6.7y ± 1.7 after initial surgery. Mean preoperative and last follow-up thoracic vertebrae height were respectively 13.5 mm ± 1.7 and 17.4 mm ± 1.7 (p < 0.001). 93% facets joints were fused (out of 320 analyzed joints), corresponding to 15/16 vertebral levels. Ossification around the rods was observed in 6.5±2.4 levels out of 13 in the convex side, and 4.2 ± 2.2 in the concave side (p = 0.04).
This first computed quantitative study showed MIFBF in NMS preserved spinal growth, while it induced 93% of facet joints fusion. This could be is an additional argument when questionning the real need for PSF at skeletal maturity.
在接受非融合手术的神经肌肉性脊柱侧凸（NMS）患儿骨骼成熟后，后路脊柱融合术（PSF）仍然是金标准。本 CT 研究的目的是通过微创非融合双极固定术（MIFBF）量化延长程序结束时自发骨融合的情况，从而避免 PSF。
纳入接受 MIFBF 治疗的 T1 至骨盆的 NMS 患者，并在最终延长程序后进行 CT 检查。术后至少 5 年进行 CT 检查。在冠状面和矢状面（右侧和左侧，从 T1 到 L5）以及椎弓根周围（轴向平面，右侧和左侧，从 T5 到 L5）对自发融合进行完全或未融合的分类。评估椎体高度。
纳入 10 例患者（初始手术时 10.7 岁±2 岁）。术前平均 Cobb 角为 82°±20°，末次随访时为 37°±13°。初始手术后平均 6.7 岁±1.7 岁进行 CT 检查。术前和末次随访时的平均胸椎高度分别为 13.5 毫米±1.7 毫米和 17.4 毫米±1.7 毫米（p<0.001）。320 个分析关节中，有 93%的关节突关节融合（15/16 个椎体水平）。凸侧 13 个椎体中有 6.5±2.4 个椎体有椎弓根周围骨化，凹侧有 4.2±2.2 个椎体（p=0.04）。
这是第一项使用 CT 进行定量研究的结果，表明 MIFBF 在 NMS 中保留了脊柱生长，同时诱导了 93%的关节突关节融合。这在质疑骨骼成熟时是否真正需要 PSF 时，可以作为一个额外的论据。
