Limitations of posterior spinal fusion to L5 for flaccid neuromuscular scoliosis focusing on pelvic obliquity
Limitations of posterior spinal fusion to L5 for flaccid neuromuscular scoliosis focusing on pelvic obliquity
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DOI：
10.1007/s43390-020-00214-1
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发表时间：
2021-03-01
期刊：
影响因子：
1.6
通讯作者：
Takaso, Masashi
中科院分区：
文献类型：
--
作者：
Saito, Wataru;Inoue, Gen;Takaso, Masashi
研究设计基于骨盆弯曲度（PO）的回顾性比较。目的评估在松弛性神经肌肉性脊柱侧凸（fNMS）患者中终止L5后路脊柱融合术（PSF）的有争议的适应证和局限性。方法对45例进行性脊柱畸形的患者采用PSF治疗至L5，平均随访4年。术后有充分的临床和放射学数据。评价前后位和侧位全脊柱X线片。我们根据最后随访时的盆腔炎（PO）程度将患者分为两组。从两组的影像学数据进行了分析，以确定这种手术方法的适应症和局限性集中在PO.ResultsPreoperatively，两组之间有显着差异，在Cobb角，PO，胸腰椎后凸，腰椎前凸（LL），而坐; Cobb角和LL，而仰卧（仰卧Cobb，仰卧LL）;和主要曲线的灵活性。多变量logistic回归分析确定仰卧Cobb和仰卧LL是最终随访时残留PO的独立风险因素（仰卧位Cobb：比值比，1.1; 95%置信区间1.0-1.2，仰卧位LL：比值比，0.9; 95%置信区间0.8-1.0）结论术前Cobb角较大和仰卧位LL较小的患者可能无法获得足够的脊柱和骨盆矫正，这可能导致PO随着时间的推移而恶化，即使在L5脊柱融合结束后。
Study designRetrospective comparison based on the degree of pelvic obliquity (PO).PurposeTo assess the controversial indications for and limitations of ending the instrumentation for posterior spinal fusion (PSF) at L5 in patients with flaccid neuromuscular scoliosis (fNMS).MethodsWe reviewed the cases of 45 patients with progressive spinal deformity as a result of fNMS treated by PSF to L5 and followed for an average of 4 years postoperatively with adequate clinical and radiological data. Anterior-posterior and lateral whole spine radiographs were evaluated. We divided patients into two groups based on the degree of pelvic obliquity (PO) at the final follow-up. Radiographic data from the two groups were analyzed to identify the indications and limitations of this surgical method focusing on PO.ResultsPreoperatively, there were significant differences between the two groups in Cobb angle, PO, thoracolumbar kyphosis, and lumbar lordosis (LL) while sitting; Cobb angle and LL while supine (Supine Cobb, and Supine LL); and major curve flexibility. Multivariate logistic regression analysis identified Supine Cobb and Supine LL as independent risk factors for residual PO at the final follow-up (Supine Cobb: odds ratio, 1.1; 95% confidence interval 1.0-1.2, Supine LL: odds ratio, 0.9; 95% confidence interval 0.8-1.0).ConclusionPatients with larger preoperative Cobb angle and smaller LL while supine may not achieve adequate spine and pelvic correction and this may lead to deterioration in the PO over time, even after spinal fusion ending at L5.