Fang Yinyu, Li Jie, Hu Zongshan, Zhu Zezhang, Qiu Yong, Liu Zhen
Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.
Neurospine. 2024 Sep;21(3):903-912. doi: 10.14245/ns.2448544.272. Epub 2024 Sep 30.
To explore the changes in coronal imbalance (CIB) in Lenke 5C adolescent idiopathic scoliosis (AIS) after posterior selective fusion surgery and determine their implications for surgical decision-making.
One hundred twenty patients were categorized according to the preoperative coronal pattern (type A, coronal balance distance [CBD]<20 mm; type B, CBD≥20 mm and coronal C7 plumbline [C7PL] shifted to the concave side of the curve; type C, CBD≥20 mm and C7PL shifted to the convex side of the curve). CIB group (CIB+) was defined as having a CBD≥20 mm at the 2-year follow-up.
Compared to type A patients, the prevalence of postoperative CIB was higher in type C patients both immediately postoperative (22% vs. 38%, p<0.05) and at the final follow-up (5% vs. 29%, p<0.05), whereas type A patients showed a greater improvement in CBD (9 of 12 vs. 6 of 24, p<0.05) at the final follow-up. The majority of patients in all groups had recovered to type A at the final follow-up (96 of 120). The proximal Cobb-1 strategy reduced the incidence of postoperative CIB (1 of 38) at the 2-year follow-up, especially in preoperative type C patients. Multivariate logistic regression analysis revealed that type C and overcorrection of the thoracolumbar curve were risk factors for CIB at the 2-year follow-up (p=0.007 and p=0.026, respectively).
Patients with type C CIB in AIS exhibited unsatisfactory restoration, with 29% of them exhibiting CIB at the final follow-up. The selective fusion strategy of proximal Cobb-1 may reduce the risk of postoperative CIB especially when the preoperative coronal pattern is type C.
探讨Lenke 5C型青少年特发性脊柱侧凸（AIS）患者后路选择性融合手术后冠状面失衡（CIB）的变化，并确定其对手术决策的影响。
120例患者根据术前冠状面形态进行分类（A型，冠状面平衡距离[CBD]<20 mm；B型，CBD≥20 mm且冠状面C7铅垂线[C7PL]向侧弯凹侧移位；C型，CBD≥20 mm且C7PL向侧弯凸侧移位）。CIB组（CIB+）定义为在2年随访时CBD≥20 mm。
与A型患者相比，C型患者术后即刻（22%对38%，p<0.05）和末次随访时（5%对29%，p<0.05）CIB的发生率更高，而A型患者在末次随访时CBD改善更明显（12例中的9例对24例中的6例，p<0.05）。所有组中的大多数患者在末次随访时恢复为A型（120例中的96例）。近端Cobb-1策略降低了2年随访时术后CIB的发生率（38例中的1例），尤其是术前C型患者。多因素logistic回归分析显示，C型和胸腰段曲线过度矫正为2年随访时CIB的危险因素（分别为p=0.007和p=0.026）。
AIS中C型CIB患者的恢复情况不理想，29%的患者在末次随访时仍存在CIB。近端Cobb-1选择性融合策略可能降低术后CIB的风险，尤其是术前冠状面形态为C型时。
