Luo Lei, Liu Liehua, Li Pei, Zhao Chen, Liang Lichuan, Gao Yongjian, Zhou Qiang
Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.
J Med Case Rep. 2025 Jul 1;19(1):295. doi: 10.1186/s13256-025-05326-8.
Although instrumented fusion is the most widely accepted surgical treatment for adolescent idiopathic scoliosis, it leads to permanent spinal motion loss and an increased risk of adjacent segment degeneration. Consequently, there is great interest in finding nonfusion methods to correct scoliosis in patients with adolescent idiopathic scoliosis. The aim of this manuscript is to report a case of adolescent idiopathic scoliosis (Lenke 5C) treated by dynamic stabilization without fusion using the Dynesys system.
The patient was a 17-year-old East Asian female. Before the operation, the major lumbar curve was 32.2° and the lumbosacral curve was 18.5°, with the Risser sign at grade 4. The procedure was performed using the Wiltse approach. The extent of fixation was from the cephalic horizontal vertebra to sacrum. The scoliosis was corrected by the unequal length of the spacers on the concave/convex side. We obtained a good correction of scoliosis, which was maintained during the 5-year follow-up. We also observed less intraoperative blood loss, faster postoperative recovery, and more motion preservation.
In this case, dynamic stabilization was demonstrated to be technically feasible for the treatment of thoracolumbar/lumbar moderate scoliosis. The benefits are related to less damage to the soft tissues, reduced blood loss, and motion preservation. However, further studies are needed to determine the effectiveness of the described surgical strategy.
尽管器械融合术是青少年特发性脊柱侧凸最广泛接受的手术治疗方法，但它会导致脊柱永久性活动丧失，并增加相邻节段退变的风险。因此，人们对寻找非融合方法来矫正青少年特发性脊柱侧凸患者的脊柱侧凸有着浓厚的兴趣。本文的目的是报告一例使用Dynesys系统进行动态稳定非融合治疗的青少年特发性脊柱侧凸（Lenke 5C型）病例。
患者为一名17岁的东亚女性。术前，主要腰椎弯度为32.2°，腰骶弯度为18.5°，Risser征为4级。手术采用Wiltse入路。固定范围从上方水平椎体至骶骨。通过凹/凸侧间隔器长度不等来矫正脊柱侧凸。我们获得了良好的脊柱侧凸矫正效果，且在5年随访期间得以维持。我们还观察到术中出血量较少、术后恢复较快以及更多的活动保留。
在该病例中，动态稳定术被证明在技术上对于治疗胸腰段/腰椎中度脊柱侧凸是可行的。其益处与对软组织的损伤较小、失血减少以及活动保留有关。然而，需要进一步研究来确定所描述手术策略的有效性。
