Minato Keitaro, Ohashi Masayuki, Watanabe Kei, Hirano Toru, Hasegawa Kazuhiro, Sato Masayuki, Makino Tatsuo, Tashi Hideki, Kawashima Hiroyuki
Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan.
Niigata Spine Surgery Center, Niigata City, Japan.
Sci Rep. 2025 May 14;15(1):16783. doi: 10.1038/s41598-025-01604-z.
Lenke type 1 adolescent idiopathic scoliosis (AIS) is characterized by a structural main thoracic (MT) curve and a non-structural proximal thoracic (PT) curve. Accurate prediction of postoperative PT curve correction is crucial for achieving optimal surgical outcomes, including postoperative shoulder balance. This study aimed to determine which preoperative lateral bending and traction radiographs are most appropriate for assessing spontaneous postoperative PT curve correction. Fifty-five patients with Lenke type 1 AIS who underwent PSF between January 2006 and January 2020 were included. Preoperative curve flexibility was assessed using side-bending (SB), fulcrum-bending (FB), and traction (TR) radiographs. Radiographic measurements were conducted preoperatively, immediately postoperatively, and at the 2-year follow-up. The average preoperative Cobb angles for PT, main thoracic (MT), and thoracolumbar/lumbar (TL/L) curves were 24.7°, 53.5°, and 32.4°, respectively. SB radiographs demonstrated a significant correlation with 2-year postoperative PT Cobb angles (r = 0.526, p < 0.001), with no significant difference between preoperative SB measurements and actual 2-year postoperative outcomes (mean difference - 0.03°; 95%CI - 1.57 to 1.49; p = 0.88). FB radiographs accurately reflected MT correction but overestimated PT correction (mean difference 2.29°; 95%CI - 0.51 to 5.10; p = 0.11), while TR radiographs underestimated PT correction. These results indicate that SB radiographs can be used as a reliable reference for estimating postoperative spontaneous PT curve correction in Lenke type 1 AIS.
Lenke 1型青少年特发性脊柱侧凸（AIS）的特征是存在结构性的胸主弯（MT）和非结构性的胸近端弯（PT）。准确预测术后PT弯的矫正情况对于实现最佳手术效果至关重要，包括术后肩部平衡。本研究旨在确定哪些术前侧弯和牵引X线片最适合评估术后PT弯的自发矫正情况。纳入了2006年1月至2020年1月期间接受后路脊柱融合术（PSF）的55例Lenke 1型AIS患者。术前通过侧弯（SB）、支点弯曲（FB）和牵引（TR）X线片评估脊柱弯曲的柔韧性。在术前、术后即刻和2年随访时进行X线测量。PT、胸主弯（MT）和胸腰段/腰段（TL/L）曲线术前平均Cobb角分别为24.7°、53.5°和32.4°。SB X线片显示与术后2年PT Cobb角有显著相关性（r = 0.526，p < 0.001），术前SB测量值与术后实际2年结果之间无显著差异（平均差异-0.03°；9５%CI -1.57至1.49；p = ０.88）。FB X线片准确反映了MT的矫正情况，但高估了PT的矫正情况（平均差异2.29°；95%CI -0.51至5.10；p = 0.11），而TR X线片低估了PT的矫正情况。这些结果表明，SB X线片可作为估计Lenke 1型AIS术后PT弯自发矫正情况的可靠参考。
