Bourghli Anouar, Boissiere Louis, Konbaz Faisal, Larrieu Daniel, Almusrea Khaled, Obeid Ibrahim
Spine Surgery Department, King Faisal Specialist Hospital and Research Center, P.O.Box 3354, 11211, Riyadh, Saudi Arabia.
Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France.
Spine Deform. 2025 May;13(3):921-928. doi: 10.1007/s43390-024-01027-2. Epub 2024 Dec 24.
To assess the radiological outcomes and complications focusing on distal junctional failure (DJF) of adult spinal deformity patients who underwent thoracolumbar fixation with the use of offset sublaminar hooks (OSH) distally.
Retrospective review of a prospective, multicenter adult spinal deformity database (2 sites). Inclusion criteria were age of at least 18 years, presence of a spinal deformity with thoraco-lumbar instrumentation ending distally with OSH (pelvis excluded), with minimum 2 years of follow-up. Demographic data, spinopelvic parameters, functional outcomes and complications were collected. Data was analyzed using descriptive statistics. Statistical significance was set to p < 0.05.
32 patients met the inclusion criteria, with the main etiologies being Scheuermann kyphosis and post-traumatic kyphosis. There was a significant correction of thoracic or thoraco-lumbar kyphosis (from 83° to 45° in case of posterior column osteotomy, p < 0.001, and from 49° to 11° in case of a three-column osteotomy, p < 0.001). DJF occurred in 9.3% of the patients including 1 patient who presented distal hook dislodgement and 2 patients who presented a compression fracture below the lowest instrumented vertebra. Oswestry Disability Index score improved in the majority of the patients (from 34.3 to 18.1, p < 0.05).
This is the first paper to propose offset sublaminar hook as a safe and efficient tool for protection of the distal end of the construct in kyphotic ASD surgery when not going down to the pelvis. It showed satisfactory radiological and clinical outcome with an acceptable rate of complications and no distal junctional failure that required revision surgery.
评估成年脊柱畸形患者在胸腰椎固定手术中使用远端偏置椎板下钩（OSH）后，重点关注远端交界性失败（DJF）的影像学结果和并发症。
对一个前瞻性、多中心的成年脊柱畸形数据库（2个地点）进行回顾性研究。纳入标准为年龄至少18岁，存在脊柱畸形且胸腰椎内固定以OSH结束于远端（不包括骨盆），随访至少2年。收集人口统计学数据、脊柱骨盆参数、功能结果和并发症。使用描述性统计分析数据。统计学显著性设定为p < 0.05。
32例患者符合纳入标准，主要病因是Scheuermann驼背和创伤后驼背。胸椎或胸腰椎后凸有显著矫正（后路截骨时从83°矫正至45°，p < 0.001；三柱截骨时从49°矫正至11°，p < 0.001）。9.3%的患者发生DJF，包括1例出现远端钩移位的患者和2例在最低固定椎体下方出现压缩骨折的患者。大多数患者的Oswestry功能障碍指数评分有所改善（从34.3降至18.1，p < 0.05）。
本文首次提出在不涉及骨盆的后凸成人脊柱畸形手术中，偏置椎板下钩是保护内固定远端的一种安全有效的工具。它显示出令人满意的影像学和临床结果，并发症发生率可接受，且无需翻修手术的远端交界性失败情况。
