Ohrt-Nissen Søren, Heegaard M, Andersen Thomas, Gehrchen M, Dahl B, Tøndevold N
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet University of Copenhagen, Inge Lehmansvej 6, 2100, Cph E, Copenhagen, Denmark.
Eur Spine J. 2024 Jun;33(6):2457-2462. doi: 10.1007/s00586-024-08246-1. Epub 2024 Apr 12.
The purpose of the study was to assess the changes in flexibility during night-time bracing in skeletally immature adolescent idiopathic scoliosis (AIS) with curves in the surgical range.
We included a consecutive cohort of 89 AIS patients with curves ≥ 45° and an estimated growth potential. All patients were eventually treated with fusion surgery, and all patients had side-bending radiographs prior to both bracing and surgery. Curves were classified as structural or non-structural curves according to Lenke at both timepoints.
The main curve progressed by a mean of 12 ± 10° and the secondary curve by 8 ± 8°. Flexibility of the main curve decreased from 50 ± 19% to 44 ± 19% (p = 0.001) and the underlying curve from 85 ± 21% to 77 ± 22% (p = 0.005). In 69 patients (79%), the Lenke category did not progress during bracing. In 14 patients (15%), the progression in Lenke type occurred in the thoracic region (i.e., Lenke type 1 to type 2), while six patients (7%) progressed in the lumbar region (i.e., type 1 to type 3). In the 69 patients that did not progress, we found that the last touched vertebra moved distally by one or two levels in 26 patients.
This is the first study to describe that curve flexibility decreases during bracing in severe AIS. However, this had only a modest impact on the surgical strategy. Bracing as a holding strategy can be applied, but the risk of losing flexibility in the lumbar spine should be outweighed against the risks of premature fusion surgery.
本研究旨在评估骨骼未成熟的青少年特发性脊柱侧凸（AIS）患者在夜间支具治疗期间，手术范围内曲线的柔韧性变化。
我们纳入了连续队列中的89例曲线≥45°且有预估生长潜力的AIS患者。所有患者最终均接受了融合手术，且所有患者在支具治疗和手术前均进行了侧弯X线片检查。在两个时间点，根据Lenke分类法将曲线分为结构性或非结构性曲线。
主曲线平均进展12±10°，次曲线进展8±8°。主曲线的柔韧性从50±19%降至44±19%（p = 0.001），潜在曲线从85±21%降至77±22%（p = 0.005）。69例患者（79%）在支具治疗期间Lenke分类未进展。14例患者（15%）在胸段出现Lenke类型进展（即从Lenke 1型进展为2型），而6例患者（7%）在腰段进展（即从1型进展为3型）。在69例未进展的患者中，我们发现26例患者中最后触及的椎体向远侧移动了1或2个节段。
这是第一项描述严重AIS患者在支具治疗期间曲线柔韧性下降的研究。然而，这对手术策略的影响不大。可以采用支具作为一种维持策略，但腰椎失去柔韧性的风险应与过早进行融合手术的风险相权衡。
