Kamata Yasuhiro, Suzuki Satoshi, Takeda Kazuki, Iga Takahito, Takahashi Yohei, Tsuji Osahiko, Nagoshi Narihito, Matsumoto Morio, Nakamura Masaya, Watanabe Kota
Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
Spine Surg Relat Res. 2025 Mar 7;9(4):453-459. doi: 10.22603/ssrr.2024-0299. eCollection 2025 Jul 27.
Surgical outcomes for adult patients with residual adolescent idiopathic scoliosis (AdIS) with a major thoracic curve are expected to be inferior to those of AIS but have not been well reported. This study aimed to evaluate surgical, radiographical, and clinical results in adult patients with AdIS and to characterize these patients by comparing their results with those of patients with adolescent idiopathic scoliosis (AIS).
Thirty-five patients with AdIS, who were diagnosed with AIS Lenke type 1 or 2 before the age of 19 years and underwent surgery after the age of 20 years, were included in the study. As a control group, 84 patients with AIS Lenke type 1 or 2 who underwent surgery before the age of 19 were included. Both groups were matched on the basis of the preoperative main thoracic (MT) and proximal thoracic (PT) Cobb angles, causing 30 patients to be selected in each group.
The AdIS group exhibited a greater preoperative bending Cobb angle of the MT and PT curves (MT: 35.1° vs. 31.3°, PT: 17.8° vs. 13.8°) and a lower MT curve flexibility index than in the AIS group (36.6% vs. 42.2%). Postoperatively, the AdIS group had a higher number of fused intervertebral segments than did the AIS group (8.2 vs. 7.4), but the correction rate was comparable in the 2 groups. Moreover, the intraoperative time was longer and blood loss was larger in the AdIS group. In the Scoliosis Research Society (SRS)-22 score, self-image and mental health domains were significantly lower preoperatively in the AdIS group. Postoperative improvement of self-image domain was significantly greater in the AdIS group (Δ self-image: 1.6 vs. 0.9), and postoperative satisfaction was similar in the 2 groups.
Surgical invasiveness was increased in AdIS, and preoperative SRS-22 scores were lower in self-image and mental health domains than in AIS. However, postoperative SRS-22 scores were comparable, and postoperative self-image improvement was significantly greater in AdIS than in AIS.
患有残留青少年特发性脊柱侧凸（AdIS）且主要为胸弯的成年患者的手术效果预计不如青少年特发性脊柱侧凸（AIS）患者，但相关报道较少。本研究旨在评估成年AdIS患者的手术、影像学和临床结果，并通过将其结果与青少年特发性脊柱侧凸（AIS）患者的结果进行比较来对这些患者进行特征描述。
本研究纳入了35例AdIS患者，这些患者在19岁之前被诊断为AIS Lenke 1型或2型，并在20岁之后接受了手术。作为对照组，纳入了84例在19岁之前接受手术的AIS Lenke 1型或2型患者。两组根据术前主胸弯（MT）和近端胸弯（PT）的Cobb角进行匹配，每组各选取30例患者。
AdIS组术前MT和PT曲线的弯曲Cobb角更大（MT：35.1°对31.3°，PT：17.8°对13.8°），且MT曲线柔韧性指数低于AIS组（36.6%对42.2%）。术后，AdIS组融合的椎间节段数比AIS组多（8.2对7.4），但两组的矫正率相当。此外，AdIS组的手术时间更长，术中出血量更大。在脊柱侧凸研究学会（SRS）-22评分中，AdIS组术前自我形象和心理健康领域的得分显著更低。AdIS组术后自我形象领域的改善显著更大（自我形象变化值：1.6对0.9），两组术后满意度相似。
AdIS患者的手术侵袭性增加，术前SRS-22评分在自我形象和心理健康领域低于AIS患者。然而，术后SRS-22评分相当，且AdIS患者术后自我形象改善比AIS患者显著更大。
