Jabbouri Sahir S, Joo Peter, David Wyatt B, Jeong Seongho, Moran Jay, Jonnalagadda Anshu, Tuason Dominick
Department of Orthopaedic Surgery, Yale University School of Medicine, New Haven, CT, USA.
Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
J Spine Surg. 2024 Jun 21;10(2):177-189. doi: 10.21037/jss-24-1. Epub 2024 May 29.
Adolescent idiopathic scoliosis (AIS) surgery typically involves posterior spinal fusion (PSF) using rods contoured by the surgeon, which may be time-consuming and may not reliably restore optimal sagittal alignment. However, pre-contoured patient-specific rods may more optimally restore sagittal spinal alignment. This study evaluates the radiographic outcomes of AIS patients who underwent PSF utilizing surgeon contoured pre-contoured rods.
This is a retrospective cohort study of AIS patients who underwent PSF with either surgeon contoured or pre-contoured rods. Demographics, Lenke classification, fused levels, osteotomies, estimated blood loss (EBL), and surgical time were also obtained via chart review. Coronal curve magnitude, T5-T12 thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), PI-LL mismatch, and T1 pelvic angle (TPA) were obtained pre-operatively, postoperatively and at last follow up. Outcome measures included rate of achievement of postoperative radiographic alignment goals (TK between 20 and 40 degrees, PI-LL mismatch within 10 degrees, and TPA <14 degrees). Predicted post-operative sagittal alignment was also compared with observed measurements. Student's and paired -tests were performed to determine significant mean differences for continuous variables, and chi-square for categorical variables.
No differences were found in demographics, Lenke classification, preop radiographic measurements, fused levels, osteotomies, EBL, and surgical time in the surgeon contoured cohort (n=36; average follow up 11.3 months) and pre-contoured cohort (n=22; average follow up 9.7 months). At last follow up, 95.5% of patients with pre-contoured rods 61.1% of patients with surgeon contoured rods (P=0.004) met TK goal. During assessment of first standing postoperative X-ray, 72.7% of patients with pre-contoured rods 33.3% of patients with surgeon contoured rods met PI-LL mismatch goal (P=0.004). Other radiographic measurements were similar. Artificial intelligence (AI) predicted and observed differences for the pre-contoured group were 3.7 for TK (P=0.005), -7.6 for PI-LL mismatch (P=0.002), and -2.6 for TPA (P=0.11).
AI and pre-contoured rods help achieve global sagittal balance with high accuracy and improved kyphosis restoration and PI-LL mismatch than surgeon contoured rods in AIS patients.
青少年特发性脊柱侧凸（AIS）手术通常涉及使用由外科医生塑形的棒进行后路脊柱融合（PSF），这可能耗时且可能无法可靠地恢复最佳矢状位对线。然而，预先塑形的个体化棒可能更能优化恢复脊柱矢状位对线。本研究评估了接受使用外科医生塑形棒或预先塑形棒进行PSF的AIS患者的影像学结果。
这是一项对接受使用外科医生塑形棒或预先塑形棒进行PSF的AIS患者的回顾性队列研究。还通过病历审查获取了人口统计学数据、Lenke分类、融合节段、截骨术、估计失血量（EBL）和手术时间。在术前、术后及末次随访时获取冠状面曲线大小、T5 - T12胸椎后凸（TK）、腰椎前凸（LL）、骨盆入射角（PI）、PI - LL失配及T1骨盆角（TPA）。结果指标包括术后影像学对线目标的达成率（TK在20至40度之间、PI - LL失配在10度以内、TPA <14度）。还将预测的术后矢状位对线与观察测量值进行了比较。进行了学生t检验和配对t检验以确定连续变量的显著平均差异，以及卡方检验用于分类变量。
在外科医生塑形组（n = 36；平均随访11.3个月）和预先塑形组（n = 22；平均随访9.7个月）中，在人口统计学数据、Lenke分类、术前影像学测量、融合节段、截骨术、EBL和手术时间方面未发现差异。在末次随访时，使用预先塑形棒的患者中有95.5% 使用外科医生塑形棒的患者中有61.1%（P = 0.004）达到了TK目标。在评估术后首次站立位X线时，使用预先塑形棒的患者中有72.7% 使用外科医生塑形棒的患者中有33.3%达到了PI - LL失配目标（P = 0.004）。其他影像学测量结果相似。人工智能（AI）预测与预先塑形组观察到的差异，TK为3.7（P = 0.005），PI - LL失配为 - 7.6（P = 0.002），TPA为 - 2.6（P = 0.11）。
与外科医生塑形棒相比，人工智能和预先塑形棒有助于在AIS患者中高精度地实现整体矢状位平衡，并改善后凸恢复和PI - LL失配情况。
