Sagittal Spinal Profile in Patients with Lumbosacral Hemivertebra: Preoperative Status and Postoperative Evolution at a Mean Follow-up of 7.5 Years.

IF 4.4 1区医学 Q1 ORTHOPEDICS

Journal of Bone and Joint Surgery, American Volume Pub Date : 2025-02-06 DOI:10.2106/JBJS.24.00260

Zhuosong Bai, Haoran Zhang, Yuechuan Zhang, Tongyin Zhang, Xiangjie Yin, Yunze Han, Yiqiao Zhang, Qianyu Zhuang, Jianguo Zhang

{"title":"Sagittal Spinal Profile in Patients with Lumbosacral Hemivertebra: Preoperative Status and Postoperative Evolution at a Mean Follow-up of 7.5 Years.","authors":"Zhuosong Bai, Haoran Zhang, Yuechuan Zhang, Tongyin Zhang, Xiangjie Yin, Yunze Han, Yiqiao Zhang, Qianyu Zhuang, Jianguo Zhang","doi":"10.2106/JBJS.24.00260","DOIUrl":null,"url":null,"abstract":"Background: A lumbosacral hemivertebra (LSHV) presents a complex challenge in treating congenital scoliosis. Previous studies have proven the effectiveness of posterior LSHV resection. However, they have primarily focused on coronal balance, neglecting the sagittal alignment, which is crucial for spinal function. The aim of this retrospective study was to assess preoperative sagittal imbalance in patients with an LSHV and to evaluate the evolution of sagittal alignment following posterior hemivertebra resection and short-segment fusion.Methods: A retrospective analysis was performed that included 58 patients with LSHV who underwent posterior LSHV resection between 2010 and 2020 and had a mean follow-up duration of 7.5 years. All patients were Han Chinese, and 30 of the 58 patients were female. The mean age was 7.3 years. Sagittal balance parameters were measured preoperatively and at multiple postoperative time points. Clinical outcomes were assessed with use of the Scoliosis Research Society (SRS)-22 questionnaire.Results: Preoperatively, 60.3% of patients presented with sagittal imbalance (defined as a sagittal vertical axis [SVA] of >20 mm). Postoperatively, the mean SVA significantly improved, decreasing to <20 mm at the 1-year follow-up (p = 0.016). The pelvic incidence-lumbar lordosis mismatch (PI-LL) also showed significant improvement at the immediate postoperative time point (p = 0.012) and at the last follow-up (p = 0.013). Patients who underwent anterior column reconstruction demonstrated better postoperative global sagittal balance than those who did not (SVA, p = 0.015; PI-LL, p < 0.001). SRS-22 total, self-image, and satisfaction scores significantly (p < 0.001) improved postoperatively.Conclusions: This study highlighted the prevalence of preoperative sagittal imbalance in patients with an LSHV and emphasized the impact of LSHV resection (particularly when accompanied by anterior column reconstruction) in achieving postoperative sagittal balance and in enhancing patient quality of life during the long-term follow-up period.Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4000,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Bone and Joint Surgery, American Volume","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2106/JBJS.24.00260","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: A lumbosacral hemivertebra (LSHV) presents a complex challenge in treating congenital scoliosis. Previous studies have proven the effectiveness of posterior LSHV resection. However, they have primarily focused on coronal balance, neglecting the sagittal alignment, which is crucial for spinal function. The aim of this retrospective study was to assess preoperative sagittal imbalance in patients with an LSHV and to evaluate the evolution of sagittal alignment following posterior hemivertebra resection and short-segment fusion.

Methods: A retrospective analysis was performed that included 58 patients with LSHV who underwent posterior LSHV resection between 2010 and 2020 and had a mean follow-up duration of 7.5 years. All patients were Han Chinese, and 30 of the 58 patients were female. The mean age was 7.3 years. Sagittal balance parameters were measured preoperatively and at multiple postoperative time points. Clinical outcomes were assessed with use of the Scoliosis Research Society (SRS)-22 questionnaire.

Results: Preoperatively, 60.3% of patients presented with sagittal imbalance (defined as a sagittal vertical axis [SVA] of >20 mm). Postoperatively, the mean SVA significantly improved, decreasing to <20 mm at the 1-year follow-up (p = 0.016). The pelvic incidence-lumbar lordosis mismatch (PI-LL) also showed significant improvement at the immediate postoperative time point (p = 0.012) and at the last follow-up (p = 0.013). Patients who underwent anterior column reconstruction demonstrated better postoperative global sagittal balance than those who did not (SVA, p = 0.015; PI-LL, p < 0.001). SRS-22 total, self-image, and satisfaction scores significantly (p < 0.001) improved postoperatively.

Conclusions: This study highlighted the prevalence of preoperative sagittal imbalance in patients with an LSHV and emphasized the impact of LSHV resection (particularly when accompanied by anterior column reconstruction) in achieving postoperative sagittal balance and in enhancing patient quality of life during the long-term follow-up period.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Bone and Joint Surgery, American Volume 医学-外科

CiteScore

8.90

自引率

7.50%

发文量

660

审稿时长

1 months

期刊介绍： The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.