Differences in early sagittal plane alignment between thoracic and lumbar adolescent idiopathic scoliosis

Background contextIt has previously been shown that rotational stability of spinal segments is reduced by posteriorly directed shear loads that are the result of gravity and muscle tone. Posterior shear loads act on those segments of the spine that are posteriorly inclined, as determined by each individual's inherited sagittal spinal profile. Accordingly, it can be inferred that certain sagittal spinal profiles are more prone to develop a rotational deformity that may lead to idiopathic scoliosis; and lumbar scoliosis, on one end of the spectrum, develops from a different sagittal spinal profile than thoracic scoliosis on the other end.PurposeTo examine the role of sagittal spinopelvic alignment in the etiopathogenesis of different types of idiopathic scoliosis.Study design/settingMulticenter retrospective analysis of lateral radiographs of patients with small thoracic and lumbar adolescent idiopathic scoliotic curves.Patients sampleWe included 192 adolescent idiopathic scoliosis patients with either a thoracic (n=128) or lumbar (n=64) structural curve with a Cobb angle of less than 20° were studied. Children with other spinal pathology or with more severe idiopathic scoliosis were excluded, because this disturbs their original sagittal profile. Subjects who underwent scoliosis screening and had a normal spine were included in the control cohort (n=95).Outcome measuresThoracic kyphosis, lumbar lordosis, T9 sagittal offset, C7 and T4 sagittal plumb lines, pelvic incidence, pelvic tilt, and sacral slope, as well as parameters describing orientation in space of each individual vertebra between C7 and L5 and length of the posteriorly inclined segment.MethodsOn standardized lateral radiographs of the spine, a systematic, semi-automatic measurement of the different sagittal spinopelvic parameters was performed for each subject using in-house developed computer software.ResultsEarly thoracic scoliosis showed a significantly different sagittal plane from lumbar scoliosis. Furthermore, both scoliotic curve patterns were different from controls, but in a different sense. Thoracic kyphosis was significantly decreased in thoracic scoliosis compared with both lumbar scoliosis patients and controls. For thoracic scoliosis, a significantly longer posteriorly inclined segment, and steeper posterior inclination of C7–T8 was observed compared with both lumbar scoliosis and controls. In lumbar scoliosis, the posteriorly inclined segment was shorter and located lower in the spine, and T12–L4 was more posteriorly inclined than in the thoracic group. The lumbar scoliosis cohort had a posteriorly inclined segment of the same length as controls, but T12–L2 showed steeper posterior inclination. Lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope, however, were similar for the two scoliotic subgroups as well as the controls.ConclusionsThis study demonstrates that even at an early stage in the condition, the sagittal profile of thoracic adolescent idiopathic scoliosis differs significantly from lumbar scoliosis, and both types of scoliosis differ from controls, but in different aspects. This supports the theory that differences in underlying sagittal profile play a role in the development of different types of idiopathic scoliosis.     

青少年特发性脊柱侧凸的冠状位畸形对矢状位参数的影响

目的 :探讨青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者的冠状位畸形和矢状位平衡间的关系。方法:回顾2006年6月~2012年10月收治的AIS患者的影像学资料,测量参数包括:结构性侧凸的Cobb角、胸椎后凸(thoracic kyphosis,TK)、腰椎前凸(lumbar lordosis,LL)、骶骨倾斜角(sacral slope,SS)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、脊柱骶骨角(spine-sacral angle,SSA)以及C7转移比值(C7 translation ratio,C7TR)。记录患者侧凸的Lenke类型和Roussouly类型,比较不同Lenke曲线类型(curve types,CT)、Lenke腰弯修正(lumbar modifiers,LM)、侧弯数量(curve amounts,CA)组间的矢状位参数;对冠、矢状面的参数进行相关性研究。结果:共获得165例AIS患者的影像学资料,男45例,女120例,平均年龄14.8±2.0岁。Lenke 1型70例,2型33例,3型15例,4型21例,5型17例,6型9例。PI平均值为43.0°±9.3°。不同CT组的TK、PT间的差异有统计学意义,其他参数间的差异无统计学意义。不同CA组的TK、LL、PT间的差异显著(P0.05),而不同LM仅有TK不同(P0.05)。不同侧凸类型患者的Roussouly类型的分布情况相似(P=0.753)。胸弯的Cobb角与LL、SS、SSA呈负相关(P0.05),腰弯的Cobb角与矢状位参数间无显著相关性。结论:AIS患者的冠状位畸形可影响部分矢状位参数的值,但不影响整体矢状位类型的分布情况。不同AIS类型的TK、LL和PT不同,而其他参数并无明显差异。脊柱侧凸矫形手术需要考虑冠、矢状位参数间的上述关系。     

Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis

The aim of this study is to quantify the changes in the sagittal alignment of the cervical spine in patients with adolescent idiopathic scoliosis following posterior spinal fusion. Patients eligible for study inclusion included those with a diagnosis of mainly thoracic adolescent idiopathic scoliosis treated by means of posterior multisegmented hook and screw instrumentation. Pre and post-operative anterior–posterior and lateral radiographs of the entire spine were reviewed to assess the changes of cervical sagittal alignment. Thirty-two patients (3 boys, 29 girls) met the inclusion criteria for the study. The average pre-operative cervical sagittal alignment (CSA) was 4.0° ± 12.3° (range −30° to 40°) of lordosis. Postoperatively, the average CSA was 1.7° ± 11.4° (range −24° to 30°). After surgery, it was less than 20° in 27 patients (84.4%) and between 20° and 40° in 5 patients (15.6%). The results of the present study suggest that even if rod precontouring is performed and postoperative thoracic sagittal alignment is restored, improved or remains unchanged after significant correction of the deformity on the frontal plane, the inherent rigidity of the cervical spine limits changes in the CSA as the cervical spine becomes rigid over time.     

成人特发性脊柱侧凸患者脊柱-骨盆矢状位平衡分析

目的:分析不同类型成人特发性脊柱侧凸(IS)患者的脊柱-骨盆矢状位平衡情况。方法:回顾分析2002年4月~2009年4月收治的83例成人IS患者,男16例,女67例,年龄20~84岁,平均43岁。在全脊柱站立位X线正侧位片(包括双侧髋关节)上测量侧凸Cobb角、胸椎后凸角(TK)、胸腰段后凸角(TLJ)、腰椎前凸角(LL)、骨盆入射角(PI)、骶骨倾斜角(SS)、骨盆倾斜角(PT)以及C7铅垂线与S1后上缘的水平距离(SVA)。将患者分为胸弯组和腰弯组,比较两组患者的脊柱-骨盆矢状位参数,分析各参数间的相关性及各参数与年龄的相关性。结果:胸弯组共39例,平均年龄40.9岁,主弯角度平均45.8°;腰弯组共44例,平均年龄44.8岁,主弯角度平均39.5°。两组患者的年龄无统计学差异(P>0.05)。两组的TK、TLJ、LL、PI、SS、PT均无统计学差异(P>0.05),但腰弯组的SVA明显大于胸弯组(P<0.05)。在≤40岁患者中,胸弯组和腰弯组患者的脊柱-骨盆矢状位序列无统计学差异(P>0.05);在>40岁患者中,腰弯组患者SVA和PT大于胸弯组(P<0.05),余参数两组间无统计学差异(P>0.05)。胸弯组9例(23.1%)出现脊柱失平衡,其中7例为负向失平衡;腰弯组12例(27.3%)出现脊柱失平衡,其中8例为正向失平衡。两组的LL与TK、SS有相关性,PI与PT、SS有相关性,SVA与LL、SS、PT有相关性,年龄与SVA、PT有相关性。与胸弯组不同,腰弯组患者的PI与LL无相关性,而年龄与LL、SS有相关性,PT与LL、SS有相关性。结论:成人IS中,胸弯和腰弯患者的骨盆形态无差别,骨盆与脊柱的矢状位序列密切相关,年龄与躯干平衡相关。胸弯患者易出现脊柱负向失平衡,而腰弯患者更易出现脊柱正向失平衡。     

Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis

Purpose

Surgical adolescent idiopathic scoliosis (AIS) management can be associated with loss of thoracic kyphosis and a secondary loss of lumbar lordosis leading to iatrogenic flatback. Such conditions are associated with poorer clinical outcomes during adulthood. The aim of this study was to evaluate sagittal plane reciprocal changes after posterior spinal fusion in the setting of AIS.

Methods

Thirty consecutive adolescents (mean age 14.6 years) with AIS Lenke 1, 2 or 3 were included in this retrospective study with 2 year follow-up. Full-spine standing coronal and lateral radiographs were obtained preoperatively, at 3 and 24 months postoperatively. Coronal Cobb angle, thoracic kyphosis (TK) and lumbar lordosis (LL) were measured. Surgical procedure was similar in all the cases, with use of pedicular screws between T11 and the lowest instrumented vertebra (≥L2), sublaminar hooks applied in compression at the upper thoracic level and sub-laminar bands and clamps in the concavity of the deformity. Statistical analysis was done using t test and Pearson correlation coefficient.

Results

Between preoperative and last follow-up evaluations a significant reduction of Cobb angle was observed (53.6° vs. 17.2°, p < 0.001). A significant improvement of the instrumented thoracic kyphosis, TK (19.7° vs. 26.2°, p < 0.005) was noted, without difference between 3 and 24 months postoperatively. An improvement in lumbar lordosis, LL (43.9° vs. 47.3°, p = 0.009) was also noted but occurred after the third postoperative month. A significant correlation was found between TK correction and improvement of LL (R = 0.382, p = 0.037), without correlation between these reciprocal changes and the amount of coronal correction.

Conclusion

Results from this study reveal that sagittal reciprocal changes occur after posterior fusion when TK is restored. These changes are visible after 3 months postoperatively, corresponding to a progressive adaptation of patient posture to the surgically induced alignment. These changes are not correlated with coronal plane correction of the deformity. In the setting of AIS, TK restoration is a critical goal and permits favorable postural adaptation. Further studies will include pelvic parameters and clinical scores in order to evaluate the impact of the noted reciprocal changes.     

Relationship between cervical sagittal alignment and health-related quality of life in adolescent idiopathic scoliosis

Purpose

Little information is available on the relationship between cervical sagittal alignment and health-related quality of life (HRQOL) in adolescent idiopathic scoliosis (AIS) patients. The aim of this study was to identify relationships between postoperative cervical sagittal alignment and HRQOL in AIS.

Methods

The study and control groups comprised 67 AIS patients (51 girls and 16 boys). All underwent anteroposterior and lateral plain radiography and completed clinical questionnaires. The radiographic parameters investigated were pre- and postoperative C2–C7 lordosis, C2–C7 sagittal vertical axis (SVA), T1 slope, T1 slope minus C2–C7 lordosis (TS-CL), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI). The Korean version of the SRS-22 questionnaire and the previously validated Short Form-36 (SF-36) outcome questionnaire were administered to evaluate HRQOL at last follow-up visits. Statistical analysis was performed to determine the significances of differences between preoperative and last follow-up radiological findings. In addition, correlations between radiological parameters and clinical questionnaire scores were sought.

Results

Radiological sagittal parameters were found to be significantly increased after surgical correction in terms of C2–C7 lordosis (3.5 ± 11.4), C2–C7 SVA (1.5 ± 6.0), T1 slope (3.5 ± 6.1), and TK (6.0 ± 8.1). However, no significant difference was observed for TS-CL, LL, PT, SS, and PI (P > 0.05). Correlation analysis revealed significant relationships between radiographic parameters and questionnaire scores. Multiple regression analysis was performed to identify predictors of HRQOL, and the results obtained revealed that postoperative T1 slope significantly predicted SRS, PCS, and MCS scores and that postoperative C2–C7 SVA predicted SRS scores.

Conclusions

Changes in cervical sagittal parameters were significant after deformity correction in AIS patients. Correlation analysis revealed significant relationships between postoperative radiographic parameters and HRQOL. In particular, T1 slope and C2–C7 SVA were found to be significant predictors of HRQOL in AIS patient.

     

Lenke 5型青少年特发性脊柱侧凸患者后路矫形术后颈椎矢状位曲度的改变

目的 :分析Lenke 5型青少年特发性脊柱侧凸(AIS)患者颈椎矢状位曲度(CSA)在后路矫形术后改变的特点。方法:回顾性分析2011年7月～2017年7月解放军总医院脊柱外科收治的43例Lenke 5型AIS患者的临床资料。在术前、术后及末次随访时的X线片上测量颈椎前凸角(CL)、胸椎后凸角(TK)、胸腰段后凸角(TLK)、腰椎前凸角(LL)、融合节段内腰椎前凸角(LIF)、C7矢状位垂直距离(SVA)。同时统计患者的基本资料,包括性别、年龄、Risser征、随访时间、融合节段椎体数目(NVF)及术前胸腰段/腰弯(TL/L Curve,TL/L C)。依据患者术前CSA分为颈椎前凸组(L组,术前CL0°)、颈椎后凸组(K组,术前CL≥0°);依据患者末次随访时CSA较术前的改变分为颈椎前凸增加组(I组)与颈椎前凸减少组(D组)。使用t检验分析L组与K组、I组与D组对应参数的差异性,使用LSD-t检验分析各组内术前、术后、末次随访时参数的差异。使用Pearson相关性检验分析CL与I组和D组各参数的相关性。检验水准为双侧α=0.05。结果:43例患者中男10例,女33例;年龄15.90±4.98岁,随访时间22.84±14.10个月。L组15例,K组17例;I组26例,D组17例。L组与K组、I组与D组的基本资料无显著性差异。所有患者末次随访时TK较术前增加(P=0.000);术后TLK与术前比较有显著性差异(P=0.000);CL在术前、术后及末次随访时无统计学差异。L组与K组术前CL(P=0.000)、LIF(P=0.029)、SVA(P=0.003)差异有统计学意义(P0.05)。K组末次随访时CL较术前改善(P=0.025),TK较术前增加(P=0.000);术后TLK较术前减小(P=0.002)并维持至末次随访(P=0.002)。I组与D组术前LL(P=0.043)、CL(P=0.009)有显著性差异(P0.05)。I组末次随访时CL较术前改善(P=0.008),TK较术前(P=0.000)及术后(P=0.001)增加;术后TLK较术前减小(P=0.005)并维持到末次随访时(P=0.006)。D组术后LL较术前增加(P=0.011)并维持到末次随访(P=0.001)。I组术前CL与TK、SVA有相关性;D组CL术前与LL、SVA,术后与TLK、SVA,末次随访时与TLK有相关性。结论:术前颈椎后凸的患者较颈椎前凸的患者在术后CSA的改善更为明显;随访中TK增加、术后TLK改善可能有助于CSA的改善;术后只有LL增加而无TK、TLK的改变则可能不会引起CSA改善。     

Role of thoracoscopy for the sagittal correction of hypokyphotic adolescent idiopathic scoliosis patients

Purpose

Thoracic adolescent idiopathic scoliosis (AIS) curves (Lenke 1–4) are often characterized by hypokyphosis. Sagittal alignment remains challenging to correct, even with recent posterior segmental instrumentation. Some authors recommend anterior endoscopic release (AER) to reduce anterior column height, and facilitate thoracic kyphosis correction. The aim of this study was to assess the contribution of AER to sagittal correction in hypokyphotic AIS.

Methods

Fifty-six hypokyphotic (T4T12<20°) AIS patients were included. In group 1 (28 patients), patients first underwent AER, followed by posterior instrumentation and correction 5–7 days later. In group 2 (28 patients), patients underwent the same posterior procedure without AER. Posterior correction was performed in all cases using posteromedial translation and hybrid constructs consisting of lumbar pedicle screws and thoracic sublaminar bands. From radiological measurements performed using low-dose EOS radiographs, the correction of thoracic kyphosis was compared between the two groups.

Results

Groups 1 and 2 were comparable regarding demographic data and preoperative thoracic kyphosis (group 1: 11.7° ± 6.9° vs group 2: 12.1° ± 6.3°, p = 0.89). Postoperative thoracic kyphosis increase averaged 18.3° ± 13.6° in group 1 and 15.2° ± 9.0° in group 2. The benefit of anterior release was not statistically significant (p = 0.35).

Conclusion

Although previous studies have suggested that thoracoscopic release improved correction compared to posterior surgery alone, the current study did not confirm this finding. Moreover, results of the current series showed that no significant benefit can be expected from AER in terms of sagittal plane improvement when the posteromedial translation technique is used, even in challenging hypokyphotic patients.     

重度成人特发性脊柱侧凸脊柱-骨盆矢状面特点分析

【摘要】 目的：探讨重度成人特发性脊柱侧凸患者脊柱-骨盆矢状面平衡特点。方法：本研究纳入79名正常志愿者（正常组）、83例轻中度成人特发性脊柱侧凸患者（Cobb角<60°）以及69例重度成人特发性脊柱侧凸患者（Cobb角>80°）,再根据主弯部位分为胸弯组及胸腰弯/腰弯组,测量各组冠状面参数包括主弯Cobb角、冠状面偏移（CB）以及顶椎偏移（AVT）,矢状面参数包括矢状面偏移（SVA）、胸椎后凸角（TK）、胸腰后凸角（TLK）、腰椎前凸角（LL）、骨盆入射角（PI）、骨盆倾斜角（PT）和骶骨倾斜角（SS）、骨盆厚度（PTH）、骶骨股骨距离（SFD）、骶骨骨盆角（PRS1）、PI与LL差值（PI-LL）、PT与PI比值（PT/PI）以及C7铅垂线与骶骨中心距离（HA-C7PL）。比较各组间冠状面及矢状面参数的特点及各参数间的相关性。相关性分析使用Pearson相关分析。不同疾病组同一参数间的对比研究使用单因素方差分析及两两比较q检验。结果：与正常组相比,重度成人特发性脊柱侧凸患者的LL、TLK、TK及PRS1显著增大,PI、PT、PTH、SFD及PI-LL显著减小,重度胸腰弯/腰弯组的SVA显著增大而SS显著减小,但SVA在平衡范围内。正常组与轻中度胸弯组,冠状面及矢状面参数间无相关性。在轻中度胸腰弯/腰弯组、重度胸弯组及重度胸腰弯/腰弯组,Cobb角与TK、TLK具有相关性。在所有组中,LL与TK、LL与TLK、PI与PT及PI与SS均具有相关性。在正常组、重度胸弯组及重度胸腰弯/腰弯组中,TK与TLK具有相关性。轻中度胸腰弯/腰弯组CB与PT具有相关性;重度胸弯组中,CB与TLK、SS具有相关性;重度胸腰弯/腰弯组,冠状面Cobb角与LL及CB与PT、SS具有相关性。在重度胸腰弯/腰弯组中,LL与SVA具有相关性。在重度脊柱侧凸组中,TK与SVA具有相关性。结论：重度成人特发性脊柱侧凸矢状面排列具有自身特点,表现为TK、TLK、LL的显著增大与PI、PT的显著减小;冠状面参数中冠状面主弯Cobb角与TK、TLK及CB与SS均具有相关性,矢状面参数中TK、TLK与LL三者之间及TK与SVA之间均具有相关性;骨盆发生明显的形态学改变,表现为狭长水平的形态。     

青少年特发性脊柱侧凸脊柱-骨盆矢状面形态的性别差异

[目的]比较男性和女性AIS患者脊柱及骨盆矢状面形态的差异,探讨AIS患者自然史性别差异的可能原因.[方法]研究收集48例男性和104例女性AIS患者的站立位、侧位X线片.所有患者均未经治疗且需要手术矫形.在侧位X线片上测量胸椎后凸(thoracic kyphosis,TK)、胸腰段后凸(thoracolumbar kyphosis,TL)、腰椎前凸(lumbar lodorsis,LL)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)及骨盆投射角(pelvic inci-dence,PI).采用成组t检验比较两组间的差异,并用Peason相关分析骨盆参数和脊柱参数间的相关性.[结果]两组患者年龄、骨龄、侧凸类型及严重性无明显差异.女性AIS患者TL及PI分别为(3.0±10.4)°和(45.2±11.0)°,男性患者则分别为(-0.9±10.5)°和(41.4±l1.7)°,两组间差异有统计学意义(P＜0.05).两组患者的TK、LL、PT和SS均无统计学差异.两组患者的PI均与PT、SS、TL和LL显著相关,TK与LL相关性有统计学意义(P＜0.05).[结论]男性AIS患者的PI值明显低于女性,表明两者可能存在不同的生长发育模式;男性患者的TL较女性患者低,提示女性AIS胸腰段的稳定性可能较男性患者差.这些差异均可能与AIS侧凸进展的性别差异有关.     

The importance of sagittal alignment in patients with adolescent idiopathic scoliosis and early onset scoliosis: A review on preoperative versus postoperative changes

Scoliosis is a three-dimensional spine deformity that in pediatric patients can progressively worsen to cause esthetic issues in adolescent idiopathic scoliosis (AIS) and lung complications in early-onset scoliosis (EOS). Previous emphasis was placed on only correcting coronal plane deformity, but recent research has demonstrated the importance of correcting sagittal plane alignment as well. Failure to do so can lead to adjacent segment disease or abnormal global sagittal balance which negatively affects quality of life. This review article summarizes current concepts of sagittal spine alignment in terms of radiographic parameters, outcomes, and complications when surgically treating patients with AIS and EOS.     

青少年特发性脊柱侧凸术后疗效的评估

青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）是指一组青少年起病、不明病因的脊柱侧向弯曲大于10°伴有椎体旋转的三维脊柱畸形,发病率较高,严重危害青少年的身心健康。随着三维矫形理论和内固定器械的发展,AIS的治疗取得了长足进步。尤其是全椎弓螺钉固定技术的出现,大大提高了AIS手术的矫正率。然而,AIS的治疗应以追求患者生存质量的改善为最终目的,手术的矫正率并非越高越好,因此,全面评价AIS术后疗效应成为AIS手术治疗的一个重要部分,而全面的评价必须包括主客观两个方面的丰旨标．     

Relationship between thoracic hypokyphosis, lumbar lordosis and sagittal pelvic parameters in adolescent idiopathic scoliosis

Purpose

Sagittal spine and pelvic alignment of adolescent idiopathic scoliosis (AIS) is poorly described in the literature. It generally reports the sagittal alignment with regard to the type of curve and never correlated to the thoracic kyphosis. The objective of this study is to investigate the relationship between thoracic kyphosis, lumbar lordosis and sagittal pelvic parameters in thoracic AIS.

Methods

Spinal and pelvic sagittal parameters were evaluated on lateral radiographs of 86 patients with thoracic AIS; patients were separated into hypokyphosis group (n = 42) and normokyphosis group (n = 44). Results were statistically analyzed. The lumbar lordosis was lower in the hypokyphosis group, due to the low proximal lordosis. The thoracic kyphosis was not correlated with any pelvic parameters but with the proximal lordosis. The pelvic incidence was correlated with sacral slope, pelvic tilt, lumbar lordosis and highly correlated with distal lumbar lordosis in the two groups. There was a significant linear regression between thoracic kyphosis and proximal lordosis and between pelvic incidence and distal lordosis.

Conclusions

We can consider that the proximal part of the lordosis depends on the thoracic kyphosis and the distal part depends on the pelvic incidence. The hypokyphosis in AIS is independent of the pelvic parameters and could be described as a structural parameter, characteristic of the scoliotic deformity.     

Evaluation of a new sagittal classification system in adolescent idiopathic scoliosis

European Spine Journal - The purpose of the present study was to validate a new spinal sagittal classification. We retrospectively included 105 consecutive AIS patients who underwent posterior...     

Lenke 1C型青少年特发性脊柱侧凸选择性融合术后参数变化

[目的]研究经椎弓根螺钉内固定选择性融合术后Lenke 1C型AIS患者矢状面参数的变化及与冠状面参数或骨盆参数之间的相关关系。[方法]选择41例连续观察的Lenke 1C型特发性脊柱侧凸患者,均行后路椎弓根螺钉固定、选择性融合术。术后随访2年。术前、术后2个月、术后2年均行站立位全脊柱正侧位X线片检查,并行影像学测量与统计。[结果]平背畸形组(胸椎后凸角<20°)患者,术后2个月(19.59±9.59)°、2年(20.45±3.59)°与术前(11.82±3.32)°比较,胸椎后凸角明显增加(P=0.010),术后2个月与2年比较,胸椎后凸角能保持稳定(P=0.998)。胸椎后凸角术后2年变化量与腰椎前凸角2年变化量、术前腰椎前凸角、骨盆投射角呈显著性相关(r值分别为-0.652,0.635,0.805,P值分别为0.041,0.049,0.005)。[结论]椎弓根螺钉内固定系统能改善平背畸形Lenke1C型患者的胸椎后凸。选择性融合术中,胸椎后凸的纠正在维持脊柱矢状位平衡中发挥重要作用。     

Thoracic sagittal plane variations between patients with thoracic adolescent idiopathic scoliosis and healthy adolescents

Purpose

To analyze the sagittal thoracic parameters of different types of progressive thoracic adolescent idiopathic scoliosis (AIS) patients and compare them with healthy adolescents.

Methods

115 AIS patients with main thoracic curves (Cobb: 59.4 ± 12.7) were prospectively compared with 116 healthy adolescents. The AIS and control (C) groups were homogeneous in terms of age and gender. Standing sagittal radiographs were analyzed for differences in T5–T12 kyphosis, T5–T8 and T9–T12 segmental kyphosis, the change between these two angles, and the double rib contour sign. Statistical analyses were performed using the χ ², one-way ANOVA, Mann–Whitney U and Student’s t tests.

Results

The sagittal parameters of Lenke 1 curves did not differ from healthy adolescents (T5–T8: 17.1 ± 10 vs C: 16 ± 7; T9–T12: 6.3 ± 7 vs C: 7.9 ± 5; T5–T12: 23.9 ± 14 vs C: 23.9 ± 8). Compared with the controls, Lenke type 3 curves were globally more hypokyphotic (T5–T12: 18.9 ± 12 vs C: 23.9 ± 8, P = 0.027) due to a “lordosis” of the lower thoracic segment (T9–T12: 0.9 ± 10 vs C: 7.9 ± 5, P = 0.001). Type 2 curves tended to exhibit more pronounced upper thoracic kyphosis (T5–T8: 20.7 ± 12 vs C: 16 ± 7). Both types 2 and 3 require a marked TK changes in the transition between the upper and lower thoracic segments to compensate for global (T5–T12) kyphosis.

Conclusions

In this 2D analysis of moderate AIS, Lenke 1 curves exhibited normal thoracic sagittal parameters, which brings into question the effect of lordosis on the development of single thoracic curves. Lenke 3 curves exhibited lower thoracic segmental hypokyphosis, and the type 2 showed upper segmental hyperkyphosis. These results should be considered when planning a surgical strategy.

     

Digital measurement and correlation analysis of coronal and sagittal anatomic parameters in the radiographs of adolescent patients with idiopathic scoliosis

Objective

To use digital software to measure the morphologic and anatomic parameters of adolescent idiopathic scoliosis (AIS). Differences and correlations among different parameters were compared to provide an anatomic basis for the selection of treatment methods and preoperative evaluation of AIS.

Methods

Spinal radiographs were taken from 300 boys and girls (age, 10–18 years) suffering from idiopathic scoliosis in four grade-A hospitals in Inner Mongolia. After screening, 120 cases with complete imaging data were assessed. Imaging data were transferred to a work station (Dr Wise™). The anatomic indices of the Cobb Angle, CVA, AVT, TS, CA, CPT, CSI, FPT, CCA, TK, LL, SS, PT, and PI were measured.

Results

There were significant differences in AVT between different grades and types of scoliosis (F = 34.079, P = 0.000; χ² = 23.379, P = 0.000). AVT was a protective factor, and the smaller the AVT, the less severe was the scoliosis. Compared with adolescents with mild or moderate scoliosis, the Cobb angle of adolescents with severe scoliosis was negatively correlated with CCA, LL, and SS (r =  − 0.641, p < 0.05; r =  − 0.695, p < 0.01; r =  − 0.814, p < 0.01).

Conclusions

Some of the anatomic parameters in the coronal and sagittal planes of adolescents with idiopathic scoliosis were significantly different according to the severity and type of scoliosis. Significant correlations were found between more anatomic indices in adolescents with severe scoliosis than in adolescents suffering from mild or moderate scoliosis.

     

胸弯型和胸腰弯/腰弯型青少年特发性脊柱侧凸患者冠状面与矢状面参数的影像学研究

目的:探讨胸弯型和胸腰弯/腰弯型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者冠状面与矢状面参数的变化,分析两种分型矢状面各参数间的相关性.方法:纳入71例胸弯型和64例胸腰弯/腰弯型AIS患者,根据弯弧位置分为两组,并纳入40例正常青少年作为对照组进行对比研究.所有...     

Preoperative radiological and electrophysiological evaluation in 100 adolescent idiopathic scoliosis patients

This is a prospective study of spinal magnetic resonance imaging (MRI), electrophysiological recordings, and neurological examinations of 100 patients admitted for surgery for adolescent idiopathic scoliosis (AIS), which was conducted to assess the prevalence of structural and functional abnormalities within the spinal cord in patients with clinically normal neurologic condition. In all patients the clinical diagnosis and intact neurological condition was ascertained by a spinal orthopedic surgeon. Full-length spinal axis MRI studies (T1/T2 sequences) and somato-sensory evoked potentials of the tibial nerves (tSSEPs) were preoperatively assessed by independent evaluators blinded to the patients' medical histories. Structural spinal cord abnormalities were found in three of 100 AIS patients on MR imaging. In one patient a Chiari malformation type 1 with an accompanying syringomyelia was diagnosed, which required a suboccipital decompression. In the other two patients small thoracic syringomyelias were diagnosed. Abnormalities of spinal cord function were detected in 68% of the 100 patients: tSSEP latencies corrected for body height were increased in 56% of the patients; pathological differences between tSSEPs on the left and right sides were present in 17% (12% in combination with a prolongation of the latency). The findings of this study indicate that MRI and electrophysiological examinations are essential to assess spinal cord abnormalities that are clinically not detectable in AIS patients. Even in patients with intact neurologic condition and clinically typical right-curved thoracic scoliosis, the possibility of intraspinal pathologies should be ruled out by MRI. It is especially important to detect structural pathologies like syringomyelia and Chiari malformation before proceeding with scoliosis surgery, as these conditions are associated with a higher neurological risk during scoliosis surgery. The electrophysiological recordings made in the present study, with the high number of pathological tSSEPs, are indicative of functional abnormalities with a subclinical involvement of the recorded neuronal pathways. The relevance of the latter findings is not yet clear, but pre-operative tSSEP examinations offer the possibility of assessing alterations in spinal cord function that are undetectable by clinical examination.     

单胸弯及单腰弯特发性脊柱侧凸的躯体生长参数研究

 目的 探讨单胸弯及单腰弯青少年特发性脊柱侧凸(adolescent idiopathic scoliosis, AIS) 女性患者的躯体生长发育特点。方法 研究对象包括 339例 AIS女性患者和 3914位同龄健康女孩, 实 足年龄 10~17岁。单胸弯 AIS女孩(端椎位于 T₁~T₁₂之间)220例, 单腰弯 AIS女孩(端椎位于 T₁₂~L₅之 间)119例;Cobb角为 32°±10°(15°~63°)。测量所有 AIS组和对照组女孩的身高、体重及臂长, 计算体重 指数(body mass index, BMI)及下肢长度, 并根据 Bjure校正公式计算 AIS女性患者的校正身高及校正 坐高。结果 单胸弯与单腰弯 AIS患者的身高及坐高在各年龄段间差异均无统计学意义;而两组 AIS 女性患者的校正身高及坐高均明显高于同龄对照组女孩。同时两组 AIS患者的臂长及下肢长度也显著 长于正常青少年。在 15岁年龄段, 单胸弯 AIS患者的体重显著低于正常青少年, 而单腰弯 AIS患儿的 体重在各年龄段均与正常青少年相似。结论 与同年龄段正常青少年相比, 单胸弯和单腰弯 AIS患者 可能具有共同的异常生长模式;此外, 与正常女孩及单腰弯 AIS女孩相比, 单胸弯 AIS患者体内脂肪含 量偏低的趋势更为明显。