青少年特发性脊柱侧凸后路直接旋转融合术后椎间盘退变的中期结果：基于磁共振成像的平均 11.6 年随访分析。

The Mid-term Outcome of Intervertebral Disc Degeneration After Direct Vertebral Rotation in Adolescent Idiopathic Scoliosis: Magnetic Resonance Imaging-based Analysis for a Mean 11.6-year Follow-up.

机构信息

Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea.

Department of Orthopedic Surgery, The Daniel and Jane Och Spine Hospital, Columbia University, New York, NY.

出版信息

Spine (Phila Pa 1976). 2024 Dec 1;49(23):1661-1668. doi: 10.1097/BRS.0000000000004991. Epub 2024 Mar 20.

DOI:10.1097/BRS.0000000000004991

PMID:38504587

Abstract

STUDY DESIGN

A retrospective cohort study.

OBJECTIVE

To evaluate the mid-term effect of intervertebral disc degeneration (DD) in patients with adolescent idiopathic scoliosis (AIS) who underwent pedicle screw instrumentation (PSI) and rod derotation (RD) with direct vertebral rotation (DVR).

SUMMARY OF BACKGROUND DATA

Posterior spinal fusion is a mainstay of surgical treatment in AIS, and DVR is considered a main corrective maneuver for vertebral rotation. However, the mid-term effect of intervertebral DD after DVR is still unknown in AIS.

METHODS

A total of 336 vertebrae for 48 patients with AIS who underwent PSI and RD with DVR were retrospectively assessed for intervertebral DD. They were divided into two groups based upon intervertebral DD, defined as Pfirmann grade more than IV. The Pfirrmann grade and modic change were evaluated at the disc above the uppermost instrumented vertebra (UIV), the disc below the lowest instrumented vertebra (LIV), and the lumbar disc levels.

RESULTS

With the 11.6 years of mean follow-up, 41.7% (20/48) of patients exhibited DD, while modic changes were observed in 4.2% (2/48) of the included patients. The discs below the LIV, L4-5, and L5-S1 were significantly shown to have an increasing trend of Pfirmann grade. The preoperative thoracic kyphosis was significantly lower in the DD group (22.0°) than in the non-DD group (31.4°) ( P = 0.025) and negatively correlated with DD ( r = -0.482, P = 0.018). The Pfirrmann grade of L5-S1 showed a high level of correlation with DD ( r = 0.604, P < 0.001).

CONCLUSIONS

The degenerative change at the disc below the LIV, L4-5, and L5-S1 levels was observed following PSI and RD with DVR. Thoracic hypokyphosis may negatively influence intervertebral discs in patients with AIS required for deformity correction. Therefore, the restoration of thoracic kyphosis is important to prevent long-term DD in AIS.

摘要

研究设计

回顾性队列研究。

目的

评估青少年特发性脊柱侧凸（AIS）患者行椎弓根螺钉内固定（PSI）和棒旋转（RD）并直接椎体旋转（DVR）后椎间盘退变（DD）的中期疗效。

背景资料概要

脊柱融合术是 AIS 手术治疗的主要方法，DVR 被认为是矫正椎体旋转的主要矫正手段。然而，AIS 患者 DVR 后椎间盘 DD 的中期效果尚不清楚。

方法

回顾性评估了 48 例 AIS 患者 336 个节段行 PSI 和 RD 并进行 DVR 的椎间盘 DD 情况。根据椎间盘 DD 情况将患者分为两组，定义为 Pfirmann 分级大于 IV 级。在最上面的内固定椎骨（UIV）上方的椎间盘、最低的内固定椎骨（LIV）下方的椎间盘和腰椎间盘水平评估 Pfirrmann 分级和 Modic 改变。

结果

平均随访 11.6 年，48 例患者中有 41.7%（20/48）出现 DD，4.2%（2/48）的患者出现 Modic 改变。LIV 以下、L4-5 和 L5-S1 椎间盘的 Pfirmann 分级呈明显升高趋势。DD 组术前胸椎后凸角（22.0°）明显低于非 DD 组（31.4°）（P=0.025），且与 DD 呈负相关（r=-0.482，P=0.018）。L5-S1 椎间盘的 Pfirrmann 分级与 DD 呈高度相关（r=0.604，P<0.001）。