The Mid-term Outcome of Intervertebral Disc Degeneration After Direct Vertebral Rotation in Adolescent Idiopathic Scoliosis: Magnetic Resonance Imaging-based Analysis for a Mean 11.6-year Follow-up.

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2024-12-01 Epub Date: 2024-03-20 DOI:10.1097/BRS.0000000000004991

Hong Jin Kim, Dong-Gune Chang, Lawrence G Lenke, Javier Pizones, René Castelein, Per D Trobisch, Jason P Y Cheung, Se-Il Suk

{"title":"The Mid-term Outcome of Intervertebral Disc Degeneration After Direct Vertebral Rotation in Adolescent Idiopathic Scoliosis: Magnetic Resonance Imaging-based Analysis for a Mean 11.6-year Follow-up.","authors":"Hong Jin Kim, Dong-Gune Chang, Lawrence G Lenke, Javier Pizones, René Castelein, Per D Trobisch, Jason P Y Cheung, Se-Il Suk","doi":"10.1097/BRS.0000000000004991","DOIUrl":null,"url":null,"abstract":"Study design: A retrospective cohort study.Objective: To evaluate the mid-term effect of intervertebral disc degeneration (DD) in patients with adolescent idiopathic scoliosis (AIS) who underwent pedicle screw instrumentation (PSI) and rod derotation (RD) with direct vertebral rotation (DVR).Summary of background data: Posterior spinal fusion is a mainstay of surgical treatment in AIS, and DVR is considered a main corrective maneuver for vertebral rotation. However, the mid-term effect of intervertebral DD after DVR is still unknown in AIS.Methods: A total of 336 vertebrae for 48 patients with AIS who underwent PSI and RD with DVR were retrospectively assessed for intervertebral DD. They were divided into two groups based upon intervertebral DD, defined as Pfirmann grade more than IV. The Pfirrmann grade and modic change were evaluated at the disc above the uppermost instrumented vertebra (UIV), the disc below the lowest instrumented vertebra (LIV), and the lumbar disc levels.Results: With the 11.6 years of mean follow-up, 41.7% (20/48) of patients exhibited DD, while modic changes were observed in 4.2% (2/48) of the included patients. The discs below the LIV, L4-5, and L5-S1 were significantly shown to have an increasing trend of Pfirmann grade. The preoperative thoracic kyphosis was significantly lower in the DD group (22.0°) than in the non-DD group (31.4°) ( P = 0.025) and negatively correlated with DD ( r = -0.482, P = 0.018). The Pfirrmann grade of L5-S1 showed a high level of correlation with DD ( r = 0.604, P < 0.001).Conclusions: The degenerative change at the disc below the LIV, L4-5, and L5-S1 levels was observed following PSI and RD with DVR. Thoracic hypokyphosis may negatively influence intervertebral discs in patients with AIS required for deformity correction. Therefore, the restoration of thoracic kyphosis is important to prevent long-term DD in AIS.","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1661-1668"},"PeriodicalIF":2.6000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000004991","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/3/20 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Study design: A retrospective cohort study.

Objective: To evaluate the mid-term effect of intervertebral disc degeneration (DD) in patients with adolescent idiopathic scoliosis (AIS) who underwent pedicle screw instrumentation (PSI) and rod derotation (RD) with direct vertebral rotation (DVR).

Summary of background data: Posterior spinal fusion is a mainstay of surgical treatment in AIS, and DVR is considered a main corrective maneuver for vertebral rotation. However, the mid-term effect of intervertebral DD after DVR is still unknown in AIS.

Methods: A total of 336 vertebrae for 48 patients with AIS who underwent PSI and RD with DVR were retrospectively assessed for intervertebral DD. They were divided into two groups based upon intervertebral DD, defined as Pfirmann grade more than IV. The Pfirrmann grade and modic change were evaluated at the disc above the uppermost instrumented vertebra (UIV), the disc below the lowest instrumented vertebra (LIV), and the lumbar disc levels.

Results: With the 11.6 years of mean follow-up, 41.7% (20/48) of patients exhibited DD, while modic changes were observed in 4.2% (2/48) of the included patients. The discs below the LIV, L4-5, and L5-S1 were significantly shown to have an increasing trend of Pfirmann grade. The preoperative thoracic kyphosis was significantly lower in the DD group (22.0°) than in the non-DD group (31.4°) ( P = 0.025) and negatively correlated with DD ( r = -0.482, P = 0.018). The Pfirrmann grade of L5-S1 showed a high level of correlation with DD ( r = 0.604, P < 0.001).

Conclusions: The degenerative change at the disc below the LIV, L4-5, and L5-S1 levels was observed following PSI and RD with DVR. Thoracic hypokyphosis may negatively influence intervertebral discs in patients with AIS required for deformity correction. Therefore, the restoration of thoracic kyphosis is important to prevent long-term DD in AIS.

查看原文本刊更多论文

青少年特发性脊柱侧凸患者椎体直接旋转后椎间盘退变的中期结果：基于磁共振成像的平均 11.6 年随访分析。

研究设计回顾性队列研究：评估青少年特发性脊柱侧凸（AIS）患者接受椎弓根螺钉器械植入术（PSI）和椎体直接旋转术（DVR）的椎间盘退变（DD）的中期影响：背景资料摘要：脊柱后路融合术是AIS手术治疗的主要方法，而DVR被认为是椎体旋转的主要矫正方法。然而，在 AIS 中，DVR 后椎体间 DD 的中期效果尚不清楚：方法：回顾性评估了 48 名接受 PSI 和 RD 以及 DVR 的 AIS 患者的 336 个椎体的椎间突起情况。根据椎间DD（定义为Pfirmann分级超过IV级）将他们分为两组。对最上器械椎体（UIV）上方的椎间盘、最低器械椎体（LIV）下方的椎间盘以及腰椎间盘水平的 Pfirrmann 分级和模态变化进行了评估：在平均 11.6 年的随访中，41.7%（20/48）的患者出现了腰椎间盘突出症，而 4.2%（2/48）的患者出现了模态变化。LIV 以下、L4-5 和 L5-S1 椎间盘的 Pfirmann 分级呈明显上升趋势。椎间盘突出症组患者术前的胸椎后凸度（22.0°）明显低于非椎间盘突出症组（31.4°）（P = 0.025），且与椎间盘突出症呈负相关（r = -0.482，P = 0.018）。L5-S1 的 Pfirrmann 分级与 DD 呈高度相关（r = 0.604，P < 0.001）：结论：PSI和RD与DVR术后可观察到LIV、L4-5和L5-S1水平以下椎间盘的退行性改变。对于需要进行畸形矫正的 AIS 患者来说，胸椎后凸可能会对椎间盘产生负面影响。因此，恢复胸椎后凸对预防 AIS 患者长期 DD 非常重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.