Takami Masanari, Tsutsui Shunji, Nagata Keiji, Iwasaki Hiroshi, Minamide Akihito, Yukawa Yasutsugu, Okada Motohiro, Taiji Ryo, Murata Shizumasa, Kozaki Takuhei, Hashizume Hiroshi, Yamada Hiroshi
Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
Spine Center, Dokkyo Medical University Nikko Medical Center, Nikko, Japan.
Spine Surg Relat Res. 2024 Mar 11;8(4):439-447. doi: 10.22603/ssrr.2023-0206. eCollection 2024 Jul 27.
This study aimed to compare the outcomes of corrective fusion for adult spinal deformity (ASD) in older people using two different sagittal correction goals: the conventional formula of "pelvic incidence (PI)-lumbar lordosis (LL) mismatch <10°" and an undercorrection strategy based on the range of 10°≤PI-LL≤20°.
A total of 102 consecutive patients (11 male and 91 female patients; mean age, 72.0 years) aged above 65 years with scoliosis >20° or LL<20° who had undergone long-segment fusion from the lower thoracic spine to the pelvis for ASD and had been followed-up for a minimum of two years at our institution since March 2013 were included in this retrospective study. After excluding patients with PI-LL≤-10° on postoperative standing radiographs, the remaining patients were divided into two groups: 31 patients with 10°≤PI-LL≤20° (U group) and 63 patients with -10°<PI-LL<10° (M group). Radiological and clinical outcomes were compared between the groups.
The incidence of proximal junctional kyphosis and mechanical failure was not significantly different between the groups (p=0.659 and 1.000, respectively). After excluding patients who underwent reoperation due to mechanical failure, there were no differences in the Oswestry Disability Index (ODI) and each domain of the Visual Analog Scale score, Scoliosis Research Society-22r patient questionnaire (SRS-22r), or the short form 36 health survey questionnaire at the final observation between the U (n=27) and M (n=57) groups. In addition, the non-inferiority and equivalence of the U group to the M group were demonstrated in all domains of the SRS-22r and ODI. Furthermore, the superiority of the U group was demonstrated by the functional domain of SRS-22r.
For the sagittal correction goal in corrective fusion surgery for ASD in the elderly, strict adherence to "PI-LL mismatch <10°" is not necessary and "PI-LL≤20°" may be acceptable.
本研究旨在比较采用两种不同矢状面矫正目标对老年人成人脊柱畸形（ASD）进行矫正融合的效果：传统公式“骨盆入射角（PI）-腰椎前凸（LL）失配<10°”和基于10°≤PI-LL≤20°范围的欠矫正策略。
本回顾性研究纳入了自2013年3月起在我院接受从下胸椎至骨盆的长节段融合治疗ASD且脊柱侧凸>20°或LL<20°、年龄在65岁以上、连续102例患者（11例男性和91例女性患者；平均年龄72.0岁），这些患者在我院至少随访了两年。在排除术后站立位X线片显示PI-LL≤-10°的患者后，将其余患者分为两组：31例PI-LL在10°≤PI-LL≤20°的患者（U组）和63例-10°<PI-LL<10°的患者（M组）。比较两组的影像学和临床结果。
两组近端交界性后凸和机械性失败的发生率无显著差异（分别为p=0.659和1.000）。在排除因机械性失败而接受再次手术的患者后，U组（n=27）和M组（n=57）在末次观察时的Oswestry功能障碍指数（ODI）、视觉模拟量表评分的各个领域、脊柱侧凸研究学会-22r患者问卷（SRS-22r）或简短健康调查36问卷方面均无差异。此外，在SRS-22r和ODI的所有领域均证明U组不劣于且等同于M组。此外，SRS-22r的功能领域显示U组具有优越性。
对于老年患者ASD矫正融合手术的矢状面矫正目标，不必严格遵循“PI-LL失配<10°”，“PI-LL≤20°”可能是可接受的。
