Yoshida Brandon, Leonardi Claudia, Valenzuela-Moss Jacquelyn, Andras Lindsay M, Tetreault Tyler A, Emans John B, Smith John T, Pahys Joshua M, Li G Ying, Heffernan Michael J
Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
School of Public Health, LSU Health Sciences Center, New Orleans, LA, USA.
Spine Deform. 2025 May;13(3):765-771. doi: 10.1007/s43390-024-01019-2. Epub 2024 Dec 15.
The purpose of this study was to compare the LIV selection in 'tweener' patients treated with MCGR or PSF.
A multicenter pediatric spine database was queried for ambulatory patients ages 8-11 years treated by MCGR or PSF with at least 2-year follow-up. The relationship between the LIV and preoperative spinal height, curve magnitude, and implant type were assessed. The relationship between the touched vertebrae (TV), the last substantially touched vertebrae (LSTV), the stable vertebrae (SV), and the LIV were evaluated.
One hundred and fifty-nine patients met inclusion criteria. Preoperative curve magnitude was similar between groups (MCGR 68 ± 19.0° vs. PSF 66 ± 17.2°, p = 0.6). Preoperative curve magnitude was associated with LIV, as larger curves were associated with a more caudal LIV (p = 0.0004). Distribution of the LIV was more varied in PSF compared to MCGR. L3 was the LIV in 43% of MCGR patients compared to 27% of PSF patients. A thoracic LIV was more common in the PSF group (PSF 13% vs. MCGR 1.2%, p = 0.0038). The LIV was cephalad to the SV in 68% of PSF compared to 48% of MCGR patients (p = 0.02).
The majority of LIV selection in 'tweener' patients was at L3 or below regardless of surgical strategy, likely driven by curve magnitude. However, 'tweener' patients treated with PSF had more cephalad LIV selections compared to patients treated with MCGR. Potential LIV differences should be considered when selecting MCGR vs. PSF in 'tweener' patients.
III.
本研究旨在比较接受MCGR或PSF治疗的“中间型”患者的下端融合椎（LIV）选择情况。
查询多中心儿科脊柱数据库，纳入年龄8至11岁、接受MCGR或PSF治疗且至少随访2年的门诊患者。评估LIV与术前脊柱高度、侧弯角度和植入物类型之间的关系。评估触碰椎体（TV）、最后一个实质性触碰椎体（LSTV）、稳定椎体（SV）与LIV之间的关系。
159例患者符合纳入标准。两组术前侧弯角度相似（MCGR组68±19.0°，PSF组66±17.2°，p = 0.6）。术前侧弯角度与LIV相关，侧弯角度越大，LIV越靠下（p = 0.0004）。与MCGR相比，PSF组LIV的分布更多样化。43%的MCGR患者LIV为L3，而PSF患者为27%。PSF组中胸段LIV更常见（PSF组13%，MCGR组1.2%，p = 0.0038）。68%的PSF患者LIV位于SV上方，而MCGR患者为48%（p = 0.02）。
无论采用何种手术策略，“中间型”患者的大多数LIV选择在L3或以下，这可能由侧弯角度驱动。然而，与接受MCGR治疗的患者相比，接受PSF治疗的“中间型”患者LIV选择更靠上。在“中间型”患者中选择MCGR与PSF时，应考虑潜在的LIV差异。
III级
