Department of Orthopaedics, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 5 E 98th St., 4th Floor, New York, NY, 10029, USA.
Department of Neurosurgery, Shriners Hospital-Philadelphia, Philadelphia, PA, USA.
Spine Deform. 2024 Jul;12(4):1033-1042. doi: 10.1007/s43390-024-00847-6. Epub 2024 Mar 22.
Posterior spinal fusion (PSF) is the current gold standard in surgical treatment for adolescent idiopathic scoliosis. Vertebral body tethering (VBT) is a fusionless alternative. Shoulder balance is an important metric for outcomes and patient satisfaction. Here we compare shoulder balance outcomes between PSF and VBT.
In this retrospective review, the pre-operative and post-operative absolute radiographic shoulder height (|RSH|) of 45 PSF patients were compared to 46 VBT patients. Mean values were compared and then collapsed into discrete groups (|RSH| GROUP) and compared. Patients were propensity score matched. Regression models based on pretest-posttest designs were used to compare procedure type on post-operative outcomes.
Pre-operatively there were no differences in |RSH| between PSF and VBT, however, at latest post-operative follow-up PSF maintained a larger |RSH| imbalance compared to VBT (0.91 cm vs 0.63 cm, p = 0.021). In an ANCOVA regression, PSF was associated with a larger |RSH| imbalance compared to VBT, F(1, 88) = 5.76, p = 0.019. An ordinal logistic regression found that the odds ratio of being in a worse |RSH| GROUP for PSF vs VBT is 2.788 (95% CI = 1.099 to 7.075), a statistically significant effect χ(1) = 4.658, p = 0.031. Results were similar in subgroup analyses of Lenke 1 and Lenke 2 patients, though to less statistical significance.
While PSF was found to be associated with worse |RSH| outcomes, the actual numbers (2-3 mm) are unlikely to be clinically meaningful. Thus, in this analysis, VBT can be said to show comparable shoulder balance outcomes to PSF.
后路脊柱融合术（PSF）是目前青少年特发性脊柱侧凸手术治疗的金标准。椎体束缚术（VBT）是一种无需融合的替代方法。肩部平衡是衡量结果和患者满意度的一个重要指标。在这里，我们比较了 PSF 和 VBT 之间的肩部平衡结果。
在这项回顾性研究中，比较了 45 例 PSF 患者和 46 例 VBT 患者的术前和术后绝对放射学肩高（|RSH|）。比较了平均值，然后将其合并为离散组（|RSH| GROUP）并进行比较。患者进行了倾向评分匹配。基于术前-术后设计的回归模型用于比较不同手术类型对术后结果的影响。
术前 PSF 和 VBT 之间的 |RSH| 没有差异，但在最新的术后随访时，PSF 与 VBT 相比，维持了更大的 |RSH| 失衡（0.91cm 对 0.63cm，p=0.021）。在协方差分析回归中，PSF 与 VBT 相比，|RSH| 失衡更大，F（1，88）=5.76，p=0.019。有序逻辑回归发现，PSF 与 VBT 相比，处于更差 |RSH| GROUP 的优势比为 2.788（95%CI=1.099 至 7.075），具有统计学意义的效应 χ（1）=4.658，p=0.031。在 Lenke 1 和 Lenke 2 患者的亚组分析中，结果相似，但统计学意义较小。
虽然 PSF 与更差的 |RSH| 结果相关，但实际数字（2-3mm）不太可能具有临床意义。因此，在这项分析中，可以说 VBT 与 PSF 具有相当的肩部平衡结果。
