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Selection of the lowest instrumented vertebra in main thoracic adolescent idiopathic scoliosis: Is it safe to fuse shorter than the last touched vertebra?
European Spine Journal ( IF 2.8 ) Pub Date : 2020-04-03 , DOI: 10.1007/s00586-020-06398-4
Søren Ohrt-Nissen 1 , Keith D K Luk 2 , Dino Samartzis 3 , Jason Pui Yin Cheung 2
Affiliation  

Abstract

Hypothesis

Fusing shorter than the last touched vertebra (LTV) is a safe approach in flexible main thoracic (MT) adolescent idiopathic scoliosis (AIS) curves.

Methods

This was a prospective study on consecutive AIS patients surgically treated with selective fusion of the MT curve. Fusion-level selection was based on the fulcrum-bending radiograph method. Patients were grouped based on the position of the lowest instrumented vertebra as proximal to the LTV (proxLTV, n = 43), at the LTV (atLTV, n = 45), and distal to the LTV (distLTV, n = 21).

Results

A total of 109 patients were included in the study. Preoperatively, the distLTV group had greater lumbar Cobb angle, lumbar apical translation, and less flexibility in the MT curve. At 2-year follow-up, the groups did not differ in MT curve correction, but the distLTV had larger lumbar Cobb angle, more apical translation, and worse coronal balance. Distal adding-on was observed in 11 patients (26%) in the proxLTV group, four patients (9%) in the atLTV group, and one patient (5%) in the distLTV group (p = 0.031). Adding-on was associated with younger patients and lower Risser grade at the time of surgery but not with any other radiographic parameter. No differences in SRS-22r scores were observed between the groups.

Conclusions

Proximal fusion carries the risk of adding-on, but leaving unfused segments in the lower spine increases the potential for compensatory mechanisms to improve spinal and truncal balance. In mature patients with a flexible MT curve, surgeons may consider fusion at or cranial to the LTV.



中文翻译:

青少年特发性胸椎侧凸最低位椎体的选择:比最后接触的椎体短的融合是否安全?

摘要

假设

在灵活的主胸椎 (MT) 青少年特发性脊柱侧弯 (AIS) 曲线中,融合短于最后接触的椎骨 (LTV) 是一种安全的方法。

方法

这是一项前瞻性研究,对连续 AIS 患者进行了 MT 曲线的选择性融合手术治疗。融合水平选择基于支点弯曲射线照相法。患者根据最低器械椎骨的位置分组为 LTV 近端(proxLTV,n  = 43)、LTV(atLTV,n  = 45)和 LTV 远端(distLTV,n  = 21)。

结果

该研究共包括 109 名患者。术前,distLTV 组腰椎 Cobb 角更大,腰椎根尖平移,MT 曲线柔韧性较差。2年随访时,各组MT曲线矫正无差异,但distLTV腰椎Cobb角更大,根尖平移更多,冠状平衡更差。在 proxLTV 组的 11 名患者 (26%)、atLTV 组的 4 名患者 (9%) 和 distLTV 组的一名患者 (5%) 中观察到远端附加 ( p  = 0.031)。添加与年轻患者和手术时较低的 Risser 等级相关,但与任何其他放射学参数无关。组间未观察到 SRS-22r 评分的差异。

结论

近端融合存在附加风险,但将未融合的节段留在下脊柱会增加代偿机制以改善脊柱和躯干平衡的可能性。对于具有灵活 MT 曲线的成熟患者,外科医生可能会考虑在 LTV 处或颅骨融合。

更新日期:2020-04-03
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