Verma Aman, Baishya Rahul, Kumar Anil, Abrol Vibhor, Ahuja Kaustubh, Sarkar Bhaskar, Kandwal Pankaj
Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, 249203, India.
Department of Trauma Surgery, All India Institute of Medical Sciences, Rishikesh, 249203, India.
Spine Deform. 2025 Oct 20. doi: 10.1007/s43390-025-01210-z.
Scheuermann kyphosis (SK) is a spinal deformity characterized by exaggerated kyphosis, frequently requiring surgical correction. Selection of the lowest instrumented vertebra (LIV) is critical in optimizing outcomes, with options including the stable sagittal vertebra (SSV) and first lordotic vertebra (FLV). This systematic review evaluates the clinico-radiological outcomes and complications associated with SSV and FLV as LIVs.
A systematic review were conducted following PRISMA guidelines. Seven studies comprising 311 patients (142 in the SSV group and 169 in the FLV group) were included. Outcomes analyzed included pre- and postoperative radiographic parameters (kyphosis, lumbar lordosis, sagittal balance), correction rates, incidence of distal junctional kyphosis (DJK), and revision surgery for DJK. Statistical analysis used Review Manager 5.4 with heterogeneity assessed using I and Q tests. Evidence quality was evaluated using the GRADE framework.
Pre- and postoperative kyphosis was significantly higher in the SSV group, while lumbar lordosis and sagittal balance were comparable. Although the correction rates were similar between groups, the incidence of DJK was significantly higher in the FLV group (OR 0.20, p = 0.04). Sensitivity analysis revealed that after removing the most heterogeneous study, the difference in DJK incidence was no longer statistically significant. Revision surgeries for DJK remained significantly higher in the FLV group (OR 0.26, p = 0.01).
Fusion to SSV may reduce the incidence of DJK and revision surgery compared to FLV, with comparable radiological outcomes. However, these findings were sensitive to study heterogeneity, and the significance of DJK difference disappeared after sensitivity analysis, highlighting the need for further prospective studies with larger sample sizes to strengthen the evidence.
休门氏驼背（Scheuermann kyphosis，SK）是一种以脊柱后凸畸形为特征的脊柱畸形，常需手术矫正。选择最低融合椎体（lowest instrumented vertebra，LIV）对于优化手术效果至关重要，可选择的椎体包括稳定矢状椎体（stable sagittal vertebra，SSV）和首个前凸椎体（first lordotic vertebra，FLV）。本系统评价评估了将SSV和FLV作为LIV的临床放射学结局及并发症。
按照PRISMA指南进行系统评价。纳入7项研究，共311例患者（SSV组142例，FLV组169例）。分析的结局指标包括术前和术后的影像学参数（后凸、腰椎前凸、矢状面平衡）、矫正率、远端交界性后凸（distal junctional kyphosis，DJK）的发生率以及因DJK进行翻修手术的情况。采用Review Manager 5.4进行统计分析，使用I检验和Q检验评估异质性。使用GRADE框架评估证据质量。
SSV组术前和术后的后凸角度显著更高，而腰椎前凸和矢状面平衡情况相当。尽管两组间矫正率相似，但FLV组DJK的发生率显著更高（比值比0.20，p = 0.04）。敏感性分析显示，去除异质性最高的研究后，DJK发生率的差异不再具有统计学意义。FLV组因DJK进行翻修手术的比例仍显著更高（比值比0.26，p = 0.01）。
与FLV相比，融合至SSV可能降低DJK的发生率和翻修手术的比例，且放射学结局相当。然而，这些结果对研究异质性较为敏感，敏感性分析后DJK差异的显著性消失，这凸显了需要开展更多样本量更大的前瞻性研究以强化证据。
