Campbell Richard E, Rudic Theodore, Hafey Alexander, Driskill Elizabeth, Newton Peter O, Bachmann Keith R
Department of Orthopedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA, 22908, USA.
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
Spine Deform. 2025 Jan;13(1):177-187. doi: 10.1007/s43390-024-00943-7. Epub 2024 Aug 19.
The purpose of this study is to compare postoperative outcomes between selective and non-selective fusions longitudinally over the first five postoperative years.
Patient parameters were retrieved from a multicenter, prospective, database. Patients with Lenke 1-6, B and C deformities were included. Patients were stratified into 2 groups: selective fusion (SF), if the last instrumented vertebra (LIV) was at or cranial to the lumbar apex, or non-selective fusion (NSF). Differences in coronal and sagittal radiographic outcomes were assessed with generalized linear models (GLMs) at 1-, 2- and 5- year postoperative outcomes. Five-year postoperative categorical radiographic outcomes, flexibility, scoliosis research society scores (SRS), and reoperation rates were compared between groups. Matched cohorts were created for subgroup analysis.
416 (SF:261, NF:155) patients, including 353 females were included in this study. The mean preoperative thoracic and lumbar Cobb angles were 57.3 ± 8.9 and 45.3 ± 8.0, respectively. GLMs demonstrated greater postoperative coronal deformity in the SF group (p < 0.01); however, the difference between groups did not change overtime (p > 0.05) indicating a relatively stable postoperative deformity correction. The SF group had a greater incidence of lumbar Cobb ≥ 26 degrees (p < 0.01). The NSF group demonstrated worse forward and lateral flexibility at 5-year postoperative outcome (p < 0.05). There was no difference in postoperative SRS scores between the SF and NSF groups. Reoperation rates were similar between groups.
Selective fusion results in greater coronal plane deformity; however, this deformity does not progress significantly over time compared to non-selective fusion. Selective spinal fusion may be a beneficial option for a larger subset of patients than previously identified.
III.
本研究的目的是纵向比较选择性融合与非选择性融合在术后头五年的术后结果。
从一个多中心前瞻性数据库中检索患者参数。纳入Lenke 1-6、B型和C型畸形患者。患者被分为两组：如果最后置入器械的椎体（LIV）位于腰椎顶点或其上方，则为选择性融合（SF）组；否则为非选择性融合（NSF）组。在术后1年、2年和5年时，使用广义线性模型（GLM）评估冠状面和矢状面影像学结果的差异。比较两组术后5年的分类影像学结果、柔韧性、脊柱侧弯研究学会评分（SRS）和再手术率。创建匹配队列进行亚组分析。
本研究纳入了416例患者（SF组：261例，NF组：155例），其中包括353例女性。术前胸椎和腰椎Cobb角平均分别为57.3±8.9和45.3±8.0。广义线性模型显示SF组术后冠状面畸形更大（p<0.01）；然而，两组之间的差异未随时间变化（p>0.05），表明术后畸形矫正相对稳定。SF组腰椎Cobb角≥26度的发生率更高（p<0.01）。NSF组在术后5年时的前屈和侧方柔韧性更差（p<0.05）。SF组和NSF组术后SRS评分无差异。两组再手术率相似。
选择性融合导致更大的冠状面畸形；然而，与非选择性融合相比，这种畸形不会随时间显著进展。对于比之前认定的更大一部分患者来说，选择性脊柱融合可能是一个有益的选择。
III级
