Kim Sung-Min, Son In-Seok, Kim Yong-Chan, Li Xiongjie, Jin Maolin
Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, Republic of Korea.
Medicina (Kaunas). 2025 Sep 8;61(9):1624. doi: 10.3390/medicina61091624.
: This study aimed to identify radiographic predictors and optimal cut-off values for determining the need for additional pedicle subtraction osteotomy (PSO) in patients with iatrogenic flatback syndrome following short-segment (≤3 levels) fusion surgery. : From 2011 to 2022, a total of 49 patients who underwent deformity correction for iatrogenic flatback following short-segment fusion at a single institution were included. We divided all patients into group A ( = 33, only anterior column realignment, ACR) and group B ( = 16, ACR combined with PSO). Among group A patients, we further divided them into two subgroups: The Excessive group, who developed excessive anterior disc height distraction (EADH) during surgery, and the Non-excessive group, who did not. The Receiver Operating Characteristic (ROC) curve was used to determine the cut-off values for spinopelvic parameters associated with the decision to perform additional PSO. : Group A had a significantly lower number of previously fused segments compared to Group B ( < 0.001). Preoperative C7 sagittal vertical axis (C7SVA, = 0.026) and its correction ( = 0.003) in group B were greater than those in group A. Group B showed a significantly more kyphotic preoperative fused segment angle (FSA) compared to Group A ( = 0.001). Postoperatively, EADH occurred in 7 patients (21.2%) in Group A, while no cases were observed in Group B. Subgroup analysis revealed that the dynamic segment angle (DA) was significantly lower in the Excessive group compared to the Non-excessive group ( < 0.001). The optimal cut-off values of preoperative radiographic parameters for selecting PSO were: C7-SVA > 242.8 mm, FSA > -3.2°, and DA < 4.3°. : ACR alone and ACR combined with PSO showed satisfactory outcomes in patients with iatrogenic flat back. For selected patients with preoperative C7SVA > 242.8 mm, FSA > -3.2°, or DA < 4.3°, additional PSO may be reasonable to help optimize sagittal alignment.
本研究旨在确定影像学预测指标及最佳截断值，以判定短节段（≤3个节段）融合手术后发生医源性平背综合征的患者是否需要额外进行经椎弓根截骨术（PSO）。2011年至2022年，共有49例在单一机构接受短节段融合术后医源性平背畸形矫正的患者纳入研究。我们将所有患者分为A组（n = 33，仅前路柱重建，ACR）和B组（n = 16，ACR联合PSO）。在A组患者中，我们进一步将其分为两个亚组：手术期间出现前路椎间盘高度过度撑开（EADH）的过度组和未出现的非过度组。采用受试者工作特征（ROC）曲线来确定与决定是否进行额外PSO相关的脊柱骨盆参数的截断值。A组既往融合节段数量显著低于B组（P < 0.001）。B组术前C7矢状垂直轴（C7SVA，P = 0.026）及其矫正值（P = 0.003）均大于A组。与A组相比，B组术前融合节段后凸角（FSA）显著更大（P = 0.001）。术后，A组7例患者（21.2%）发生EADH，而B组未观察到病例。亚组分析显示，过度组的动态节段角（DA）显著低于非过度组（P < 0.001）。选择PSO的术前影像学参数的最佳截断值为：C7 - SVA > 242.8 mm，FSA > -3.2°，DA < 4.3°。单独ACR及ACR联合PSO在医源性平背患者中显示出满意的疗效。对于术前C7SVA > 242.8 mm、FSA > -3.2°或DA < 4.3°的选定患者，额外进行PSO可能有助于优化矢状位对线。
