Safety and Efficacy of Treatment for Scolios Is Secondary to Spinal Muscular Atrophy Fused to Lumbar 5 Level
Safety and Efficacy of Treatment for Scolios Is Secondary to Spinal Muscular Atrophy Fused to Lumbar 5 Level
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DOI：
10.22603/ssrr.2017-0093
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发表时间：
2018-01-01
影响因子：
1.2
通讯作者：
Takaso, Masashi
中科院分区：
文献类型：
--
作者：
Takei, Shoichiro;Miyagi, Masayuki;Takaso, Masashi
前言：脊髓性肌萎缩症(SMA)患者通常伴有进行性脊柱侧弯。尽管已推荐使用骶骨或骨盆融合术来矫正骨盆倾斜，但该手术是侵入性的。方法：对12例SMA患者行腰椎后路融合术，并在L5节段停止内固定。评估手术年龄、手术时间、出血量、并发症、术前术后Cobb角及术后并发症。结果：平均手术年龄11.4岁，平均手术时间319分钟，平均出血量1170毫升。术后1个月Cobb角由97.3°提高到39.1°(矫正率为60.9%)，最终随访时为42.3°。术后1月矫正27.8°至13.1°(矫正率51.7%)，末次随访矫正至19.8°。无并发症报告。所有患者的下腰痛都有改善，坐着的困难也减少了。然而，6例术前高PO值的患者有10%的PO丢失。结论：SMA患者脊柱侧凸矫正率可接受，脊柱后路融合内固定至L5水平，无并发症发生。与SMA相关的脊柱侧弯比与Duchenne肌营养不良相关的脊柱侧弯更僵硬和严重。SMA患者的Cobb角和PO的矫正率与SMA患者的Cobb角和PO的矫正率相似。术前PO高的患者矫正度丢失明显大于术前PO低的患者。对于SMA患者的脊柱侧弯，除术前PO较高的病例外，内固定和L5融合治疗似乎是安全和有效的。
Introduction: Patients with spinal muscular atrophy (SMA) usually have progressive scoliosis. Although fusion of the sacrum or pelvis has been recommended for correcting pelvic obliquity (PO), the procedure is invasive. This study determined as to whether performing instrumentation to the fifth lumbar vertebra (L5) is safe and effective for scoliosis in patients with SMA.Methods: Twelve patients with SMA underwent posterior spinal fusion and stopping instrumentation at the L5 level. We evaluated age at surgery, the duration of surgery, blood loss, complications, preoperative and postoperative Cobb angles, and PO.Results: The mean age at surgery was 11.4 years; the mean duration of surgery was 319 minutes, and the mean blood loss was 1170 mL. The Cobb angle improved from 97.3 degrees to 39.1 degrees at 1 month postoperatively (correction rate, 60.9%) and to 42.3 degrees at the final follow-up. PO was corrected from 27.8 degrees to 13.1 degrees at 1 month postoperatively (correction rate, 51.7%) and to 19.8 degrees at the final follow-up. No complications were reported. All patients showed improvement in low back pain, with reduced difficulty while sitting. However, > 10% correction loss of PO was observed in 6 patients with high preoperative PO.Conclusions: The correction rate of scoliosis in SMA patients with posterior spinal fusion and instrumentation to the L5 level was acceptable, and no complications occurred. Scoliosis associated with SMA was more rigid and severer than scoliosis associated with Duchenne muscular dystrophy. Correction rates of the Cobb angle and PO in SMA patients with instrumentation to L5 were similar to those in SMA patients with instrumentation to the sacrum or pelvis. Correction loss of PO was greater in patients with high preoperative PO than in those with low preoperative PO. Instrumentation and fusion to L5 for scoliosis in patients with SMA seems safe and effective, except in cases of high preoperative PO.