Which thoracic curves are at the greater risk for distal adding-on: comparison between typical and atypical Lenke 1A curves
Which thoracic curves are at the greater risk for distal adding-on: comparison between typical and atypical Lenke 1A curves
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DOI：
10.1007/s00586-021-06721-7
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发表时间：
2021-03-29
影响因子：
2.8
通讯作者：
Zhu, Zezhang
中科院分区：
文献类型：
--
作者：
Yin, Rui;Qin, Xiaodong;Zhu, Zezhang
目的探讨非典型Lenke 1A型青少年特发性脊柱侧凸患者附加椎体（adding-on，AO）的发生率和特征，以及非典型Lenke 1A型和典型Lenke 1A型脊柱侧凸患者是否应采用相同的最低内固定椎体（lowest instrumented vertebra，LIV）选择策略。方法回顾性分析251例Lenke 1A患者行后路脊柱融合术的临床资料。最短随访时间为2年。根据顶点将曲线分为两组。最后，将42例不典型Lenke 1A患者（心尖位于T10/11-T11/12）分为不典型组（G1）。同时，42例年龄、性别和Cobb角匹配的典型Lenke 1A患者（心尖位于T7/8-T10）入组典型组（G2）。评价两组的影像学特征，并比较两组AO的发生率。结果非典型Lenke 1A曲线的发生率为16.7%。G1组患者的左侧胸椎弯曲度更大（P = 0.029），胸椎（P = 0.011）和腰椎弯曲度更好（P = 0.014），术前冠状面失衡更大（P = 0.001）。最终随访时，G1出现更多AO（38.1% vs. 19.0%）。特异性，对于最后一个基本接触椎骨（LSTV）近端LIV的患者，G1的AO发生率显著较高（82.4% vs. 42.9%，P = 0.022）。结论非典型Lenke 1A曲线有其自身的影像学特征。当LIV靠近LSTV时，更容易发生AO，这表明Lenke 1A的两种亚型应考虑不同的融合水平。我们建议LSTV作为LIV在非典型Lenke 1A病例中，而LSTV近端的一个水平可能在典型Lenke 1A曲线中可用。
Purpose To identify the characteristics and the incidence of adding-on (AO) in atypical Lenke 1A adolescent idiopathic scoliosis patients, and to investigate whether atypical and typical Lenke 1A curve should follow the same lowest instrumented vertebra (LIV) selection strategy. Methods A total of 251 Lenke 1A patients who underwent posterior spinal fusion were analyzed. The minimum follow-up was 2 years. Curves were classified into two groups according to the apex. At last, 42 atypical Lenke 1A patients (apex at T10/11-T11/12) were identified and divided into atypical group (G1). Meanwhile, 42 age, gender, and Cobb angle-matched typical Lenke 1A patients (apex at T7/8-T10) were enrolled into the typical group (G2). The radiographic characteristics were evaluated, and the incidence of AO was compared between the 2 groups. Results The incidence of atypical Lenke 1A curves was 16.7%. Patients in G1 were found to have more left thoracic curves (P = 0.029), better flexibility of thoracic (P = 0.011) and lumbar curve (P = 0.014), and more preoperative coronal imbalance (P = 0.001). At the final follow-up, G1 developed more AO (38.1% vs. 19.0%). Specificity, for patients with LIV proximal to last substantially touching vertebra (LSTV), the incidence of AO was significantly higher in G1 (82.4% vs. 42.9%, P = 0.022). Conclusion Atypical Lenke 1A curve had its own radiographic characteristics. It was more likely to develop AO when LIV was proximal to LSTV, which indicated different fusion levels should be considered in these two subtypes of Lenke 1A. We recommended LSTV as LIV in atypical Lenke 1A cases, while one level proximal to LSTV might be available in typical Lenke 1A curve.