Aoun Marven, Daher Mohammad, Daniels Alan H, Kreichati Gaby, Kharrat Khalil, Sebaaly Amer
Department of Orthopedic Surgery Spine Unit, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon.
Department of Orthopedic Surgery, Brown University, Providence, RI, 02906, USA.
Eur Spine J. 2025 Feb;34(2):741-747. doi: 10.1007/s00586-024-08596-w. Epub 2024 Dec 11.
With the increasing prevalence of adult spinal deformity (ASD) in the aging population, the need for corrective surgery has surged, highlighting the importance of preventing mechanical complications (MC) such as junctional kyphosis/failure and rod breakage. The Roussouly classification, which categorizes natural variations in spinal posture, may hold predictive value in assessing the risk of these complications, as it guides the restoration of sagittal alignment based on a patient's preoperative spinal shape.
PubMed, Cochrane, and Google Scholar (pages 1-20) were searched through August 2024 to find articles comparing the incidence of mechanical complications between patients who were matched and mismatched to their ideal Roussouly shape after surgery for ASD. Extracted data consisted of the risk of mechanical complications, and the risk of reoperations.
10 retrospective studies were included in this meta-analysis, with 1454 patients divided into 2 groups, the first group matching Roussouly classification (716 patients, 49%) and the second unmatched (738 patients, 51%). A 5-times lower rate of mechanical complication (Odds-Ratio = 0.22; 95% CI: 0.12-0.41, p < 0.001) was found in the matched group at an average follow-up of 3.6 years. Furthermore, when examining specific mechanical complications, there were higher rates of both PJK (Odds-Ratio = 1.59; 95% CI: 1.07-2.38, p = 0.02) and rod breakages (Odds-Ratio = 1.75; 95% CI: 1.15-2.66, p = 0.01) in the unmatched group. However, no difference in the rate of reoperations was observed between the two groups (Odds-Ratio = 0.48; 95% CI: 0.18-1.28, p = 0.14).
Matching patients to their ideal Roussouly type in adult spinal deformity surgery significantly reduces mechanical complications making it a secure and efficient method. Future studies should compare the Roussouly classification to other alignment models to determine optimal alignment for ASD correction surgery.
III.
随着老年人群中成人脊柱畸形（ASD）患病率的不断上升，矫正手术的需求激增，这凸显了预防机械并发症（MC）的重要性，如交界性后凸/失败和棒材断裂。Roussouly分类法对脊柱姿势的自然变异进行了分类，在评估这些并发症的风险方面可能具有预测价值，因为它根据患者术前的脊柱形状指导矢状面排列的恢复。
检索截至2024年8月的PubMed、Cochrane和谷歌学术（第1 - 20页），以查找比较ASD手术后与理想Roussouly形状匹配和不匹配患者之间机械并发症发生率的文章。提取的数据包括机械并发症的风险和再次手术的风险。
该荟萃分析纳入了10项回顾性研究，1454例患者分为两组，第一组符合Roussouly分类（716例患者，49%），第二组不匹配（738例患者，51%）。在平均3.6年的随访中，匹配组的机械并发症发生率降低了5倍（优势比 = 0.22；95%置信区间：0.12 - 0.41，p < 0.001）。此外，在检查特定的机械并发症时，不匹配组的近端交界性后凸（PJK）（优势比 = 1.59；95%置信区间：1.07 - 2.38，p = 0.02）和棒材断裂（优势比 = 1.75；95%置信区间：1.15 - 2.66，p = 0.01）发生率均较高。然而，两组之间再次手术率没有差异（优势比 = 0.48；95%置信区间：0.18 - 1.28，p = 0.14）。
在成人脊柱畸形手术中，将患者与理想的Roussouly类型相匹配可显著降低机械并发症，使其成为一种安全有效的方法。未来的研究应将Roussouly分类法与其他排列模型进行比较，以确定ASD矫正手术的最佳排列方式。
III级
