Strömqvist Fredrik, Vasilescu Irina, Ohlin Acke, Möller Anders, Abul-Kasim Kasim
Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopaedics, Lund University, Skane University Hospital, Malmö, Sweden.
Department of Radiology and Neuroradiology, Lund University, Skane University Hospital, Malmö-Lund, Sweden.
Eur Spine J. 2025 May;34(5):1810-1816. doi: 10.1007/s00586-025-08767-3. Epub 2025 Mar 12.
The aim of this study was to evaluate bony fusion with Low Dose CT (LDCT) over time following posterior scoliosis surgery in an all screw construct in patients with AIS with special focus on whether the spinal fusion process continue to develop beyond 2 years after scoliosis surgery and to evaluate if LDCT is an adequate radiological method to assess fusion maturation.
Twenty five consecutive patients with mean age 17 (range 13-24) were operated on during 2009-2010 with index diagnosis AIS. Two neuroradiologists used a LDCT protocol to independently evaluate the occurrence and degree of bony fusion at 2 years and 5 years after surgery (ankylosed facet joints). The instrumented spine was divided in an upper, a middle and a lower third on each side in the 25 patients, leaving 150 regions to be assessed. Fusion in each region was classified based on the status of the facet joints as total, partial or non-fusion.
Progression of fusion degree between 2 years and 5 years postoperatively occurred in 18 patients (72%). At 5 years follow-up, 60% showed evidence of total fusion and none showed non-fusion. The interobserver agreement in the classification of bony fusion 2 years postoperatively was almost perfect with a Kappa coefficient of 0.94 and between 2 and 5 years postoperatively a Kappa Coefficient of 0.90.
The fusion maturation progress continues beyond two years following posterior scoliosis surgery in AIS. LDCT is a reliable radiological method to reveal bony fusion maturation over time after posterior scoliosis surgery.
本研究旨在评估青少年特发性脊柱侧凸（AIS）患者后路脊柱侧凸手术采用全螺钉固定后，随时间推移低剂量CT（LDCT）下的骨融合情况，特别关注脊柱融合过程在脊柱侧凸手术后2年以上是否仍在继续发展，并评估LDCT是否为评估融合成熟度的合适影像学方法。
2009年至2010年期间，连续25例平均年龄17岁（范围13 - 24岁）的患者接受了以AIS为索引诊断的手术。两名神经放射科医生采用LDCT方案，独立评估术后2年和5年（小关节融合）时骨融合的发生情况和程度。在这25例患者中，将植入器械的脊柱每侧分为上、中、下三分之一，共150个区域需要评估。根据小关节的状态，将每个区域的融合情况分为完全融合、部分融合或未融合。
18例患者（72%）术后2年至5年融合程度有所进展。在5年随访时，60%显示有完全融合的证据，无未融合情况出现。术后2年骨融合分类的观察者间一致性几乎完美，Kappa系数为0.94，术后2年至5年Kappa系数为0.90。
AIS患者后路脊柱侧凸手术后，融合成熟过程在两年后仍在继续。LDCT是一种可靠的影像学方法，可用于显示后路脊柱侧凸手术后随时间推移的骨融合成熟情况。
