Dionne Alexandra C, Lenke Lawrence G, Hassan Fthimnir M, Nnake Chidebelum, Blanchard Simon, Reyes Justin L, Miller Roy, Lombardi Joseph M, Sardar Zeeshan M
Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Department of Orthopaedic Surgery, Columbia University Irving Medical Center, The Och Spine Hospital at NewYork Presbyterian, New York, NY, 10032, USA.
Eur Spine J. 2025 Feb;34(2):625-634. doi: 10.1007/s00586-024-08621-y. Epub 2024 Dec 23.
To compare the long-term outcomes among AIS (10-18 years) and young AdIS (YAdIS) (19-40 years) patients with minimum 2 year follow up.
A retrospective review of AIS and YAdIS patients who underwent primary corrective surgery at a single center was conducted. Demographic, radiographic, operative data, patient reported outcome measures (PROMs), including the ODI and SRS-22r, and long-term complications were collected. A 1:1 propensity score matched (PSM) analysis was implemented to limit selection bias by controlling for gender, curve type, total instrumented levels (TIL), and main coronal cobb angle.
95 patients (60 AIS, 35 YAdIS) were identified. Following PSM, 27 matched pairs were identified. AIS patients had greater LL (-55.6 ± 14.0 vs. -61.8 ± 11.7, p = 0.0486) at preop, less OR time (4.7 ± 1.2 h vs. 5.2 ± 1.5 h, p = 0.0468), intraoperative transfusion rates (70.4% vs. 96.3%, p = 0.0082), and postop Hb (9.0 ± 1.9 vs. 10.1 ± 1.4, p = 0.0280) and Hct (26.4 ± 5.4 vs. 29.7 ± 3.7, p = 0.0453). YAdIS patients had greater T2-T12 TK (42.7 ± 13.6 vs. 36.3 ± 11.0, p = 0.0412), T2-T5 TK (19.4 ± 9.4 vs. 13.3 ± 8.7, p = 0.0187), and TPA (12.4 ± 7.9 vs. 7.4 ± 8.9, p = 0.0200). There were no significant differences in baseline and 2 year follow up PROMs and in the rates of 2 year complications, including proximal/distal junctional kyphosis (PJK/DJK), pseudarthrosis, rod fracture, curve progression, and revision (p > 0.05).
Despite differences in operative characteristics, idiopathic scoliosis (IS) patients who underwent corrective surgery at a younger age had comparable PROMs and 2 year outcomes to older patients. Corrective fusion surgery is safe and effective in both adolescents and young adults and may avoid the higher complication rates seen in older adults.
比较年龄在10 - 18岁的青少年特发性脊柱侧凸（AIS）患者和年龄在19 - 40岁的年轻成人特发性脊柱侧凸（YAdIS）患者至少2年随访后的长期疗效。
对在单一中心接受初次矫正手术的AIS和YAdIS患者进行回顾性研究。收集人口统计学、影像学、手术数据、患者报告结局指标（PROMs），包括Oswestry功能障碍指数（ODI）和脊柱侧凸研究学会22项修订版（SRS - 22r），以及长期并发症。采用1:1倾向评分匹配（PSM）分析，通过控制性别、侧弯类型、总融合节段数（TIL）和主冠状面Cobb角来限制选择偏倚。
共纳入95例患者（60例AIS，35例YAdIS）。PSM后，确定了27对匹配病例。AIS患者术前腰椎前凸（LL）更大（-55.6±14.0 vs. -61.8±11.7，p = 0.0486），手术时间更短（4.7±1.2小时 vs. 5.2±1.5小时，p = 0.0468），术中输血率更低（70.4% vs. 96.3%，p = 0.0082），术后血红蛋白（Hb）（9.0±1.9 vs. 10.1±1.4，p = 0.0280）和血细胞比容（Hct）（26.4±5.4 vs. 29.7±3.7，p = 0.0453）更低。YAdIS患者T2 - T12胸椎后凸（TK）更大（42.7±13.6 vs. 36.3±11.0，p = 0.0412），T2 - T5 TK更大（19.4±9.4 vs. 13.3±8.7，p = 0.0187），顶椎旋转角（TPA）更大（12.4±7.9 vs. 7.4±8.9，p = 0.0200）。在基线和2年随访的PROMs以及2年并发症发生率方面，包括近端/远端交界性后凸（PJK/DJK）、假关节形成、棒材断裂、侧弯进展和翻修，均无显著差异（p > 0.05）。
尽管手术特征存在差异，但接受矫正手术的年轻特发性脊柱侧凸（IS）患者与年长患者的PROMs及2年疗效相当。矫正融合手术在青少年和年轻成人中均安全有效，且可能避免年长成人中较高并发症发生率。
