Abstract

Purpose

To investigate whether the rotation of preoperative-presumed lowest instrumented vertebra (LIV) is a risk factor for adding-on (AO) in adolescent idiopathic scoliosis (AIS) treated with selective posterior thoracic fusion (sPTF).

Methods

A total of 196 AIS patients of Lenke type 1A or 2A with minimum 2-year follow-up after sPTF with all pedicle screw instrumentation were included. Radiographical parameters were measured as follows: preoperative rotation angle of presumed LIV and LIV + 1, LIV + 1/LIV rotation difference, postoperative rotation angle of LIV and LIV derotation angle on CT scans. Patients were classified into AO group and non-AO group during the follow-up. The parameters were compared between the two groups to investigate risk factors for AO.

Results

Among 196 patients, 40 (20.4%) patients developed with AO at the final follow-up. Compared with non-AO group, patients with AO had significantly larger preoperative rotation angle of presumed LIV (8.8° ± 3.4° vs. 3.4° ± 2.9°, P < 0.001) and LIV + 1 (5.9° ± 4.0° vs. 3.6° ± 2.9°, P = 0.004), LIV + 1/LIV rotation difference (− 2.6° ± 3.7° vs. 0.6° ± 3.2°, P < 0.001) and postoperative rotation angle of LIV (7.2° ± 4.3° vs. 3.0° ± 2.9°, P < 0.001). The last substantially touched vertebrae (LSTV) was selected as LIV in 148 patients, among which the above described parameters were found to be remarkably larger in AO group than non-AO group as well. Multivariate analysis presented Risser grade and preoperative rotation angle of presumed LIV as independent predictors of AO.

Conclusion

AIS patients with low Risser grade and large preoperative rotation angle of presumed LIV are more likely to develop with AO after sPTF. Moreover, for the patients with LSTV selected as LIV, preoperative rotation of presumed LIV might be still a risk factor associated with the occurrence of AO.

Level of Evidence

III

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

中文翻译：

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术前假定最低固定椎骨的旋转：它是选择性胸椎融合治疗 Lenke 1A/2A 曲线远端附加的危险因素吗？

摘要

目的

研究术前假定的最低固定椎 (LIV) 的旋转是否是选择性后胸椎融合术 (sPTF) 治疗青少年特发性脊柱侧凸 (AIS) 的附加 (AO) 的危险因素。

方法

共纳入 196 名 Lenke 1A 或 2A 型 AIS 患者，在所有椎弓根螺钉器械的 sPTF 后至少随访 2 年。影像学参数测量如下：假定的 LIV 和 LIV + 1 的术前旋转角、LIV + 1/LIV 旋转差、术后 LIV 旋转角和 CT 扫描上的 LIV 反旋角。随访期间将患者分为AO组和非AO组。比较两组之间的参数以研究 AO 的危险因素。

结果

在 196 名患者中，40 名 (20.4%) 患者在最终随访时发展为 AO。与非 AO 组相比，AO 患者的术前推定 LIV 旋转角度显着较大（8.8°±3.4° vs. 3.4°±2.9°，P  < 0.001）和 LIV + 1（5.9°±4.0° vs. 3.6） ° ± 2.9°，P  = 0.004），LIV + 1/LIV 旋转差（- 2.6° ± 3.7° vs. 0.6° ± 3.2°，P  < 0.001）和 LIV 术后旋转角度（7.2° ± 4.3° vs. 3.0°±2.9°，P < 0.001)。148 例患者的最后一个基本接触椎骨（LSTV）被选为 LIV，其中 AO 组的上述参数也明显大于非 AO 组。多变量分析表明，假定 LIV 的 Risser 等级和术前旋转角度是 AO 的独立预测因子。

结论

sPTF 后，Risser 等级低且术前旋转角度大的 AIS 患者更容易发展为 AO。此外，对于选择为 LIV 的 LSTV 患者，假定 LIV 的术前轮换可能仍然是与 AO 发生相关的危险因素。

证据水平

三

图形摘要

这些幻灯片可以在电子补充材料下检索。