Importance of Distal Fusion Level in Major Thoracolumbar and Lumbar Adolescent Idiopathic Scoliosis Treated by Rod Derotation and Direct Vertebral Rotation Following Pedicle Screw Instrumentation
Importance of Distal Fusion Level in Major Thoracolumbar and Lumbar Adolescent Idiopathic Scoliosis Treated by Rod Derotation and Direct Vertebral Rotation Following Pedicle Screw Instrumentation
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DOI：
10.1097/brs.0000000000001998
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发表时间：
2017-08-01
期刊：
影响因子：
3
通讯作者：
Lee, Jung-Hee
中科院分区：
文献类型：
--
作者：
Chang, Dong-Gune;Yang, Jae Hyuk;Lee, Jung-Hee
研究设计.一项回顾性比较研究。本研究的目的是分析椎弓根螺钉内固定（PSI）后采用棒去旋转（RD）和直接椎体旋转（DVR）治疗胸腰椎和腰椎（TL/L）青少年特发性脊柱侧凸（AIS）的精确远端融合节段。在治疗严重TL/LAIS时，正确确定远端融合节段是矫正畸形和保留运动节段的一个非常重要的因素。对64例接受PSI、RD和DVR治疗且至少随访2年的TL/L曲线较大的AIS患者，根据术前弯曲X线片的灵活性和旋转性分为AL 3（灵活性）和BL 3（刚性）。术后（P = 0.933）和末次随访时（P = 0.144），AL 3和BL 3组之间的TL/L（主要）曲线无显著差异。此外，术后胸椎（轻微）和代偿（尾部）曲线无显著差异（胸椎曲线：P = 0.828，代偿曲线：P = 0.976）;然而，末次随访时代偿（尾部）曲线存在显著差异（P = 0.041）。结果不满意率为28.1%（18/64），其中AL 3组为15.2%（7/46），BL 3组为61.1%（11/18），差异有统计学意义（P< 0.05）。当弯曲灵活时，将在L3（EV）处选择最低的内固定椎体（LIV）;术前弯曲X线片中L3穿过CSVL，旋转小于II级。但是，如果曲线是刚性的，则LIV应扩展到L4（EV + 1），以防止在PSI之后使用RD和DVR治疗重大TL/L AIS时出现附加现象。
Study Design. A retrospective comparative study.Objective. The aim of this study was to analyze the exact distal fusion level in the treatment of major thoracolumbar and lumbar (TL/L) adolescent idiopathic scoliosis (AIS) using rod derotation (RD) and direct vertebral rotation (DVR) following pedicle screw instrumentation (PSI).Summary of Background Data. Proper determination of distal fusion level is a very important factor in deformity correction and preservation of motion segments in the treatment of major TL/L AIS.Methods. AIS patients with major TL/L curves (n = 64) treated by PSI with RD and DVR methods with a minimum 2-year follow-up were divided into AL3 (flexible) and BL3 (rigid) according to the flexibility and rotation by preoperative bending radiographs.Results. There was no significant difference in TL/L (major) curve between the AL3 and BL3 groups postoperatively (P = 0.933) and at the last follow-up (P = 0.144). In addition, there was no significant difference in thoracic (minor) and compensatory (caudal) curve postoperatively (thoracic curve: P = 0.828, compensatory curve: P = 0.976); however, there was a significant difference in compensatory (caudal) curve at the last follow-up (P = 0.041). The overall prevalence of unsatisfactory results was 28.1% (18/64 patients), and the prevalence was 15.2% (7/46) in the AL3 group and 61.1% (11/18) in the BL3 group, which was significantly different (P< 0.05).Conclusion. Lowest instrumented vertebra (LIV) would be selected at L3 (EV) when the curve is flexible; L3 crosses CSVL with a rotation of less than grade II in preoperative bending radiographs. However, if the curve is rigid, LIV should be extended to L4 (EV + 1) in order to prevent the adding-on phenomenon in the treatment of major TL/L AIS using RD and DVR following PSI.