Department of Orthopedics, Tangdu Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China.
Curr Med Res Opin. 2024 Oct;40(10):1785-1791. doi: 10.1080/03007995.2024.2391556. Epub 2024 Sep 1.
To investigate the incidence, risk factors, and clinical impact of persistent coronal imbalance (PCI) in Lenke5C adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF).
We analyzed the medical records of 112 Lenke5C AIS patients. They were grouped into PCI (+) group and PCI (-) group according to the occurrence of PCI at 2 years after surgery. Coronal and sagittal parameters were measured and compared between both groups preoperatively, immediately postoperatively, and 2 years postoperatively. Scoliosis Research Society-22 (SRS-22) score was used to evaluate clinical outcomes.
Of the 112 patients, 12 had coronal imbalance persisting 2 years after surgery. Logistic regression analysis indicated risk factors including older age [odds ratio (OR) = 1.841, 95% confidence interval (CI) = 1.147-2.132, = .001], lower preoperative flexibility main thoracic (MT) curve (OR = 1.308, 95% CI = 1.041-2.015, = .016), greater preoperative apical vertebral translation (AVT) of the thoracolumbar/lumbar (TL/L) curve (AVT-TL/L) (OR = 2.291, 95% CI = 1.120-4.719, = .001), larger preoperative lowest instrumented vertebra tilt (LIV lilt) (OR = 2.141, 95% CI = 1.491-3.651, = .011), and postoperative immediate coronal imbalance (OR = 5.512, 95% CI = 4.531-6.891, = .001). The satisfaction and total score of the SRS-22 scale in the PCI (+) group were lower than those in the PCI (-) group at 2 years after surgery ( <.05).
We found a 10.7% incidence of PCI in patients with Lenke5C AIS undergoing PSF. PCI adversely affects clinical outcomes. Risk factors of PCI included older age, reduced preoperative MT curve flexibility, increased preoperative AVT in the TL/L curve, greater preoperative LIV tilt, and immediate postoperative coronal imbalance.
研究后路脊柱融合术后持续冠状面失衡（PCI）在 Lenke5C 型青少年特发性脊柱侧凸（AIS）患者中的发生率、危险因素和临床影响。
我们分析了 112 例 Lenke5C AIS 患者的病历。根据术后 2 年是否发生 PCI，将其分为 PCI（+）组和 PCI（-）组。测量并比较两组患者术前、术后即刻和术后 2 年的冠状面和矢状面参数。采用脊柱侧凸研究学会 22 项问卷（SRS-22）评分评估临床结果。
112 例患者中，12 例术后 2 年仍存在冠状面失衡。Logistic 回归分析表明，年龄较大（比值比 [OR] = 1.841，95%置信区间 [CI] = 1.147-2.132，P =.001）、术前主胸段（MT）曲线柔韧性较低（OR = 1.308，95%CI = 1.041-2.015，P =.016）、术前胸腰椎/腰椎（TL/L）曲线顶椎偏移（AVT-TL/L）较大（OR = 2.291，95%CI = 1.120-4.719，P =.001）、术前最低置钉椎体倾斜度（LIV 倾斜度）较大（OR = 2.141，95%CI = 1.491-3.651，P =.011）以及术后即刻冠状面失衡（OR = 5.512，95%CI = 4.531-6.891，P =.001）是 PCI 的危险因素。术后 2 年时，PCI（+）组的 SRS-22 量表满意度和总分均低于 PCI（-）组（P<.05）。
我们发现行后路脊柱融合术的 Lenke5C AIS 患者中 PCI 的发生率为 10.7%。PCI 对临床结果有不良影响。PCI 的危险因素包括年龄较大、术前 MT 曲线柔韧性降低、TL/L 曲线术前 AVT 增加、术前 LIV 倾斜度增大以及术后即刻冠状面失衡。
