Predictive modeling and long-term outcomes in optimizing fusion strategies for congenital scoliosis: a retrospective analysis of posterior hemivertebra resection.

IF 2.6 3区医学 Q2 ORTHOPEDICS

International Orthopaedics Pub Date : 2025-09-01 Epub Date: 2025-07-05 DOI:10.1007/s00264-025-06595-0

Zhiming Peng, You Du, Haoran Zhang, Chenkai Li, Shengru Wang, Jianguo Zhang

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Abstract

Purpose: This study compares short-segment (2-level) versus longer-segment (> 2-level) fusion after posterior hemivertebra resection in congenital scoliosis (CS) and identifies preoperative thresholds to guide fusion strategy selection.

Methods: Eighty-eight CS patients (mean age: 5.42 years) undergoing hemivertebra resection with fusion (31 short-segment [Fused_2], 57 longer-segment [Fused_GT2]) were retrospectively analyzed. Radiographic parameters, complications, and reoperations were assessed. Logistic regression derived predictive thresholds for fusion length.

Results: Both groups achieved comparable initial (~ 77%) and final (~ 61%) main curve correction. The Fused_2 group had shorter operative time (154 vs. 204 min, p < 0.001) and lower blood loss (249 vs. 356 mL, p = 0.011). Reoperation rates (20.5% overall), crankshaft phenomenon (25.0%), and neurological complications (5.7%) did not differ between groups. Preoperative main curve ≤ 41.8° and thoracic kyphosis ≤ 30.2° predicted suitability for 2-segment fusion.

Conclusion: Short-segment fusion reduces invasiveness without compromising correction in select CS patients. Preoperative thresholds (main curve ≤ 41.8°, kyphosis ≤ 30.2°) may guide strategy, though individualized assessment remains essential.

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预测模型和优化先天性脊柱侧凸融合策略的长期结果：后路半椎体切除术的回顾性分析。

目的：本研究比较先天性脊柱侧凸（CS）后路半椎体切除术后短节段（2节段）与长节段（> 2节段）融合，并确定术前阈值以指导融合策略的选择。方法：回顾性分析88例行半椎体切除融合治疗的CS患者（31例短节段[Fused_2]， 57例长节段[Fused_GT2]），平均年龄5.42岁。评估影像学参数、并发症和再手术情况。逻辑回归得到融合长度的预测阈值。结果：两组的初始（~ 77%）和最终（~ 61%）主曲线校正率相当。Fused_2组手术时间较短（154分钟vs. 204分钟）。结论：短节段融合在不影响矫正的情况下减少了侵袭性。术前阈值（主曲线≤41.8°，后凸≤30.2°）可以指导策略，但个性化评估仍然是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Orthopaedics 医学-整形外科

CiteScore

5.50

自引率

7.40%

发文量

360

审稿时长

1 months

期刊介绍： International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters. Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.