Spinopelvic morphology impacts on postoperative proximal junctional kyphosis in congenital scoliosis with thoracolumbar hemivertebrae.

IF 1.6 Q3 CLINICAL NEUROLOGY
Spine deformity Pub Date : 2024-09-01 Epub Date: 2024-04-29 DOI:10.1007/s43390-024-00877-0
Yang Li, Chenggui Zhang, Jianmin Sun, Guodong Wang
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引用次数: 0

Abstract

Purpose: It aims to investigate the lumbar and pelvic morphology in congenital scoliosis with thoracolumbar hemivertebrae and its impact on proximal junctional kyphosis (PJK) incidence after hemivertebra resection and short fusion.

Methods: 23 congenital scoliosis patients with thoracolumbar hemivertebra aged between 10 and 18 years were enrolled in the retrospective study. Spinopelvic sagittal parameters were analyzed on whole-spine standing lateral radiographs preoperatively, one-week postoperatively and at the final follow-up. Pearson correlations were calculated for local kyphosis (LK), lumbar and pelvic morphology parameters. Binary logistic regression and receiver operating characteristics (ROC) curve analysis were performed to identify the risk factors for PJK.

Results: Thoracolumbar hemivertebra caused LK of 29.2° ± 17.3°, an increased lumbar lordosis (LL) (-64.7° ± 16.3°), lower LL apex (52.2% at L5), and small pelvic incidence (PI) (36.8° ± 6.6°). LK was correlated with lumbar morphology parameters, including LL (r = - 0.837), upper arc of LL (LLUA) (r = - 0.879), thoracolumbar kyphosis (TLK) (r = 0.933), thoracic kyphosis (TK) (r = 0.762) and TK apex (TKA) (r = - 0.749). Surgical treatment improved the lumbar morphology, but not pelvic morphology. At the final follow-up, LL had returned to its preoperative value (p = 0.158). PJK occurred in 30.4% of cases as a compensatory mechanism. Preoperatively, significant differences of parameters between non-PJK and PJK groups were observed in LK and TLK. Binary logistic regression identified three independent risk factors for PJK: preoperative LLA (OR = 0.005, 95%CI = 0.000-0.287, p = 0.011), preoperative TLK (OR = 1.134, 95%CI = 1.001-1.286, p = 0.048), and preoperative lumbar lordosis morphology type (OR = 5.507, 95%CI = 1.202-25.227, p = 0.028). However, residual LK after surgery was not correlated with PJK incidence. ROC curve analysis verified that preoperative TLK > 22.59° was associated with increased PJK incidence after surgery.

Conclusions: Lumbar morphology changes as a compensatory mechanism beneath the thoracolumbar hemivertebra. However, a stable pelvis tends to allow the LL to return to its preoperative value. PJK occurred as a cranial compensatory mechanism for increasing LL and corrected TLK. A larger TLK (> 22.59°) was an independent risk factor for PJK incidence in patients with type 2 and 3A lumbar lordosis morphology.

脊柱骨形态对伴有胸腰椎半椎体的先天性脊柱侧凸术后近端交界处脊柱侧凸的影响。
目的:研究先天性脊柱侧弯伴胸腰椎半椎体的腰椎和骨盆形态,以及其对半椎体切除和短融合术后近交界脊柱侧弯(PJK)发生率的影响。在术前、术后一周和最终随访时,通过全脊柱立位侧位片分析脊柱矢状面参数。计算了局部驼背(LK)、腰椎和骨盆形态参数的皮尔逊相关性。为确定PJK的风险因素,进行了二元逻辑回归和接收器操作特征(ROC)曲线分析:结果:胸腰椎半椎体导致 LK 为 29.2° ± 17.3°,腰椎前凸(LL)增加(-64.7° ± 16.3°),LL 顶点降低(L5 为 52.2%),骨盆入径(PI)较小(36.8° ± 6.6°)。LK 与腰椎形态参数相关,包括 LL(r = - 0.837)、LL 上弧(LLUA)(r = - 0.879)、胸腰椎后凸(TLK)(r = 0.933)、胸椎后凸(TK)(r = 0.762)和 TK 顶点(TKA)(r = - 0.749)。手术治疗改善了腰椎形态,但没有改善骨盆形态。最后随访时,LL 已恢复到术前值(p = 0.158)。作为一种代偿机制,30.4%的病例出现了 PJK。术前观察发现,非 PJK 组和 PJK 组的 LK 和 TLK 参数存在明显差异。二元逻辑回归确定了 PJK 的三个独立风险因素:术前 LLA(OR = 0.005,95%CI = 0.000-0.287,p = 0.011)、术前 TLK(OR = 1.134,95%CI = 1.001-1.286,p = 0.048)和术前腰椎前凸形态类型(OR = 5.507,95%CI = 1.202-25.227,p = 0.028)。然而,术后残留的 LK 与 PJK 发生率无关。ROC曲线分析证实,术前TLK>22.59°与术后PJK发生率增加有关:结论:腰椎形态的改变是胸腰椎半椎体下方的一种代偿机制。结论:腰椎形态的改变是胸腰椎半椎体下方的代偿机制,但稳定的骨盆可使腰椎形态恢复到术前水平。PJK 的发生是 LL 增加和 TLK 矫正的颅骨代偿机制。较大的 TLK(> 22.59°)是 2 型和 3A 型腰椎前凸形态患者发生 PJK 的独立风险因素。
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来源期刊
CiteScore
3.20
自引率
18.80%
发文量
167
期刊介绍: Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.
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