Scheer Justin K, Smith Justin S, Passias Peter G, Kim Han Jo, Bess Shay, Burton Douglas C, Klineberg Eric O, Lafage Virginie, Gupta Munish, Ames Christopher P
Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA.
Neurospine. 2023 Sep;20(3):837-848. doi: 10.14245/ns.2346454.227. Epub 2023 Sep 30.
The goal of this study was to determine if patients with mild scoliosis and age-appropriate sagittal alignment have favorable outcomes following surgical correction.
Retrospective review of a prospective, multicenter adult spinal deformity database. Inclusion criteria: operative patients age ≥18 years, and preoperative pelvic tilt, mismatch between pelvic incidence and lumbar lordosis (PI-LL), and C7 sagittal vertical axis all within established age-adjusted thresholds with minimum 2-year follow-up. Health-related quality of life (HRQoL) scores: Oswestry Disability Index (ODI), 36-item Short Form health survey (SF-36), Scoliosis Research Society-22R (SRS22R), back/leg pain Numerical Rating Scale and minimum clinically important difference (MCID)/substantial clinical benefit (SCB). Two-year and preoperative HRQoL radiographic data were compared. Patients with mild scoliosis (Mild Scoli, Max coronal Cobb 10°-30°) were compared to those with larger curves (Scoli).
One hundred fifty-one patients included from 667 operative patients (82.8% women; average age, 56.4 ± 16.2 years). Forty-two patients (27.8%) included in Mild Scoli group. Mild Scoli group had significantly worse baseline leg pain, ODI, and physical composite scores (p < 0.02). Mean 2-year maximum coronal Cobb angle was significantly improved compared to baseline (p < 0.001). All 2-year HRQoL measures were significantly improved compared to (p < 0.001) except mental composite score, SRS activity and SRS mental for the Mild Scoli group (p > 0.05). From the mild Scoli group, 36%-74% met either MCID or SCB for the HRQoL measures. Sixty-four point three percent had minimum 1 complication, 28.6% had a major complication, 35.7% had reoperation.
Mild scoliosis patients with age-appropriate sagittal alignment benefit from surgical correction, decompression, and stabilization at 2 years postoperative despite having a high complication rate.
本研究的目的是确定轻度脊柱侧弯且矢状面排列符合年龄标准的患者在手术矫正后是否能获得良好的疗效。
对一个前瞻性、多中心成人脊柱畸形数据库进行回顾性研究。纳入标准：手术患者年龄≥18岁，术前骨盆倾斜度、骨盆入射角与腰椎前凸不匹配（PI-LL）以及C7矢状垂直轴均在既定的年龄调整阈值范围内，且随访至少2年。健康相关生活质量（HRQoL）评分：Oswestry功能障碍指数（ODI）、36项简短健康调查（SF-36）、脊柱侧弯研究学会-22R（SRS22R）、腰/腿痛数字评定量表以及最小临床重要差异（MCID）/显著临床获益（SCB）。比较术前和术后2年的HRQoL及影像学数据。将轻度脊柱侧弯患者（轻度脊柱侧弯，最大冠状面Cobb角10°-30°）与侧弯较大的患者（脊柱侧弯）进行比较。
667例手术患者中纳入151例（82.8%为女性；平均年龄56.4±16.2岁）。轻度脊柱侧弯组纳入42例患者（27.8%）。轻度脊柱侧弯组的基线腿痛、ODI和身体综合评分显著更差（p<0.02）。与基线相比，平均术后2年的最大冠状面Cobb角显著改善（p<0.001）。与术前相比，所有术后2年的HRQoL指标均显著改善（p<0.001），但轻度脊柱侧弯组的心理综合评分、SRS活动和SRS心理指标除外（p>0.05）。在轻度脊柱侧弯组中，36%-74%的患者在HRQoL指标上达到了MCID或SCB。64.3%的患者至少发生1种并发症，28.6%的患者发生严重并发症，35.7%的患者接受了再次手术。
轻度脊柱侧弯且矢状面排列符合年龄标准的患者，尽管并发症发生率较高，但术后2年仍可从手术矫正、减压和稳定手术中获益。
