在使用现代后路系统的情况下，对于青少年特发性脊柱侧凸（AIS），在前路矫正、融合节段和后凸方面，前路手术是否仍优于后路矫正？

Is the anterior approach still superior to posterior correction in AIS regarding correction, fusion levels and kyphosis when modern posterior systems are used?

作者信息

Hammad Ahmed, Eberl Johanna, Wirries André, Geiger Florian

机构信息

Spine and Scoliosis Center, Hessing Foundation, Augsburg, Germany.

JW Goethe University Hospital, Frankfurt, Germany.

出版信息

Spine Deform. 2024 May;12(3):699-710. doi: 10.1007/s43390-024-00832-z. Epub 2024 Mar 12.

DOI:10.1007/s43390-024-00832-z

PMID:38468120

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11068832/

Abstract

PURPOSE

The aim of our study is to compare anterior and posterior corrections of thoracic (Lenke I) and lumbar (Lenke V) curves when modern posterior pedicle screw systems with vertebral derotation techniques are used. Curves that could not be corrected with both systems were excluded.

METHODS

A thoracic group (N = 56) of Lenke I AIS patients (18 anterior and 38 posterior) and a lumbar group (N = 42) of Lenke V patients (14 anterior and 28 posterior) with similar curves < 65° were identified.

RESULTS

Thoracic group The mean postoperative correction (POC) was 68 ± 13.4% in the anterior and 72 ± 10.5% in the posterior group. The postoperative change in thoracic kyphosis was +4° and +5° respectively. The median length of fusion was eight segments in the posterior and seven segments in the anterior groups. In 89% the LIV was EV or shorter in the anterior, and in 71% of the posterior corrections. Lumbar group The mean POC was 75 ± 18.3% (anterior) and 72 ± 8.5% (posterior). The postoperative gain in lumbar lordosis was 0.8° (anterior) and 4° (posterior). The median length of fusion was five segments in both groups and there was no difference in relation of the LIV to the EV.

CONCLUSION

With modern implants and derotation techniques, the posterior approach can achieve similar coronal correction, apical derotation and thoracic kyphosis with similar length of fusion and better lumbar lordosis restoration.

摘要

目的

我们研究的目的是比较在使用现代后路椎弓根螺钉系统及椎体去旋转技术时，胸段（Lenke I型）和腰段（Lenke V型）脊柱侧弯的前路和后路矫正效果。排除两种系统均无法矫正的侧弯。

方法

确定了胸段组（N = 56）的Lenke I型青少年特发性脊柱侧弯（AIS）患者（前路18例，后路38例）和腰段组（N = 42）的Lenke V型患者（前路14例，后路28例），其侧弯角度均<65°且相似。

结果

胸段组前路组术后平均矫正率（POC）为68±13.4%，后路组为72±10.5%。胸段后凸角术后分别增加了4°和5°。后路融合节段中位数为8个节段，前路为7个节段。在前路矫正中，89%的终末椎体（LIV）等于或短于顶椎（EV）；后路矫正中，这一比例为71%。腰段组前路平均POC为75±18.3%，后路为72±8.5%。腰椎前凸角术后增加量，前路为0.8°，后路为4°。两组融合节段中位数均为5个节段，LIV与EV的关系无差异。