定义现代医源性扁平背综合征：探讨短节段腰椎融合患者行胸腰椎畸形矫正术后的节段性前凸丢失。
Defining modern iatrogenic flatback syndrome: examination of segmental lordosis in short lumbar fusion patients undergoing thoracolumbar deformity correction.
机构信息
Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, USA.
Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA.
出版信息
Eur Spine J. 2024 Dec;33(12):4627-4635. doi: 10.1007/s00586-024-08531-z. Epub 2024 Oct 23.
PURPOSE
Understanding the mechanism and extent of preoperative deformity in revision procedures may provide data to prevent future failures in lumbar spinal fusion patients.
METHODS
ASD patients without prior spine surgery (PRIMARY) and with prior short (SHORT) and long (LONG) fusions were included. SHORT patients were stratified into modes of failure: implant, junctional, malalignment, and neurologic. Baseline demographics, spinopelvic alignment, offset from alignment targets, and patient-reported outcome measures (PROMs) were compared across PRIMARY and SHORT cohorts. Segmental lordosis analyses, assessing under-, match, or over-correction to segmental and global lordosis targets, were performed by SRS-Schwab coronal curve type and construct length.
RESULTS
Among 785 patients, 430 (55%) were PRIMARY and 355 (45%) were revisions. Revision procedures included 181 (23%) LONG and 174 (22%) SHORT corrections. SHORT modes of failure included 27% implant, 40% junctional, 73% malalignment, and/or 28% neurologic. SHORT patients were older, frailer, and had worse baseline deformity (PT, PI-LL, SVA) and PROMs (NRS, ODI, VR-12, SRS-22) compared to primary patients (p < 0.001). Segmental lordosis analysis identified 93%, 88%, and 62% undercorrected patients at LL, L1-L4, and L4-S1, respectively. SHORT patients more often underwent 3-column osteotomies (30% vs. 12%, p < 0.001) and had higher ISSG Surgical Invasiveness Score (87.8 vs. 78.3, p = 0.006).
CONCLUSIONS
Nearly half of adult spinal deformity surgeries were revision fusions. Revision short fusions were associated with sagittal malalignment, often due to undercorrection of segmental lordosis goals, and frequently required more invasive procedures. Further initiatives to optimize alignment in lumbar fusions are needed to avoid costly and invasive deformity corrections.
LEVEL OF EVIDENCE
IV: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
目的
了解翻修手术中术前畸形的机制和程度，可能为预防腰椎融合术后失败提供数据。
方法
纳入无脊柱手术史的 ASD 患者（原发性）和有短节段（SHORT）和长节段（LONG）融合史的患者。将 SHORT 患者分为失败模式：植入物、交界处、对线不良和神经。比较原发性和 SHORT 队列的基线人口统计学、脊柱骨盆对线、对线目标的偏移量以及患者报告的结果测量（PROM）。通过 SRS-Schwab 冠状曲线类型和结构长度进行节段性前凸分析，评估节段性前凸目标的下、匹配或过矫正情况。
结果
在 785 例患者中，430 例（55%）为原发性，355 例（45%）为翻修。翻修手术包括 181 例 LONG 和 174 例 SHORT 矫正。SHORT 的失败模式包括 27%的植入物、40%的交界处、73%的对线不良和/或 28%的神经。与原发性患者相比，SHORT 患者年龄更大、身体更脆弱，基线畸形（PT、PI-LL、SVA）和 PROM（NRS、ODI、VR-12、SRS-22）更差（p<0.001）。节段性前凸分析分别在 LL、L1-L4 和 L4-S1 确定了 93%、88%和 62%的矫正不足患者。SHORT 患者更常进行 3 柱截骨术（30%对 12%，p<0.001），ISSG 手术侵袭性评分更高（87.8 对 78.3，p=0.006）。
结论
近一半的成人脊柱畸形手术为翻修融合术。翻修短融合与矢状面对线不良有关，通常是由于节段性前凸目标的矫正不足，并且经常需要更具侵袭性的手术。需要进一步采取措施优化腰椎融合的对线，以避免昂贵且具有侵袭性的畸形矫正。
证据水平
IV：诊断：个体横断面研究，具有一致应用的参考标准和盲法。
Zotero 插件