Tyler A Tetreault, Tiffany N Phan, Tishya A L Wren, Michael J Heffernan, John B Emans, Lawrence I Karlin, Amer F Samdani, Ilkka J Helenius, Michael G Vitale, Lindsay M Andras
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This technique's efficacy has not been studied.</p><p><strong>Methods: </strong>Patients with EOS with GFI undergoing conversion to fusion were grouped by those that did or did not have PCO. Patients with inadequate radiographs, <2 years follow-up, or three-column osteotomies at time of fusion were excluded.</p><p><strong>Results: </strong>Eight hundred thirty-two patients met inclusion criteria. One hundred seventy-five (21%) patients had PCO. Age at index surgery was younger (6.6 vs . 7.4 y, P =0.0009), and the mean duration of GFI was greater (6.2 vs. 5.5 y, P =0.009) in the PCO group. Before fusion, curve magnitude was similar between the groups (PCO=61.9°, no PCO=59.3°, P =0.18). On average 4.4 osteotomies (range: 1-12) were performed for the PCO group and EBL (PCO=820 cc vs . no PCO=752 cc, P <0.01) and surgical time (PCO=403 min vs . no PCO=349 min, P <0.01) were greater. Postoperatively, mean curve correction (PCO=16.6°, no PCO=14.4°, P =0.18) was similar. Accounting for preoperative curve magnitude, there was a relationship between number of PCOs and curve correction ( P =0.04). There was no relationship between degrees of correction per osteotomy and duration of GFI ( P =0.12). Postoperative complications at 2 years were similar (PCO=25% vs. no PCO=27%, P =0.63).</p><p><strong>Conclusions: </strong>EOS graduates achieve minimal correction at time of conversion regardless of whether PCOs are performed. PCOs increase EBL and operative time but have a similar complication rate. 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引用次数: 0
摘要
研究设计多中心回顾性研究：确定在早发性脊柱侧凸（EOS）患者从生长友好型器械治疗（GFI）转为最终融合治疗时进行后柱截骨术（PCO）是否会影响治疗效果：背景数据摘要：使用生长友好型器械（GFI）治疗早发性脊柱侧弯症后，脊柱僵硬度的增加会限制转为最终脊柱融合术时的曲线矫正。脊柱融合术时通常会使用 PCO 来改善脊柱的柔韧性。这种技术的疗效尚未得到研究：方法：将接受脊柱融合术的 GFI EOS 患者按是否使用 PCO 进行分组。结果：832 名患者符合纳入标准：832名患者符合纳入标准。175例（21%）患者患有PCO。PCO组患者手术时的年龄更小（6.6岁对7.4岁，P =0.0009），GFI的平均持续时间更长（6.2岁对5.5岁，P =0.009）。融合前，两组的曲线幅度相似（PCO=61.9度，无PCO=59.3度，P=0.18）。PCO组和EBL组平均进行了4.4次截骨手术（范围：1 - 12）（PCO=820 cc vs no PCO=752 cc，P=0.18）：无论是否进行PCO，EOS毕业生在转换时都能达到最小的矫正效果。PCO 增加了 EBL 和手术时间，但并发症发生率相似。更多的PCO会带来更多的矫正效果，尽管比之前未植入器械的脊柱预期的矫正效果要少：证据等级：III。
Osteotomies at the Time of Graduation Surgery: How Much Do We Get From Them?
Study design: Retrospective, multicenter.
Objective: Determine if posterior column osteotomies (PCO) at time of conversion from growth friendly instrumentation (GFI) to definitive fusion in early onset scoliosis (EOS) graduates impacts outcomes.
Summary of background data: Increasing spinal rigidity following treatment of EOS with GFI can limit curve correction at time of conversion to definitive spinal fusion. PCO are often employed at the time of fusion to improve flexibility. This technique's efficacy has not been studied.
Methods: Patients with EOS with GFI undergoing conversion to fusion were grouped by those that did or did not have PCO. Patients with inadequate radiographs, <2 years follow-up, or three-column osteotomies at time of fusion were excluded.
Results: Eight hundred thirty-two patients met inclusion criteria. One hundred seventy-five (21%) patients had PCO. Age at index surgery was younger (6.6 vs . 7.4 y, P =0.0009), and the mean duration of GFI was greater (6.2 vs. 5.5 y, P =0.009) in the PCO group. Before fusion, curve magnitude was similar between the groups (PCO=61.9°, no PCO=59.3°, P =0.18). On average 4.4 osteotomies (range: 1-12) were performed for the PCO group and EBL (PCO=820 cc vs . no PCO=752 cc, P <0.01) and surgical time (PCO=403 min vs . no PCO=349 min, P <0.01) were greater. Postoperatively, mean curve correction (PCO=16.6°, no PCO=14.4°, P =0.18) was similar. Accounting for preoperative curve magnitude, there was a relationship between number of PCOs and curve correction ( P =0.04). There was no relationship between degrees of correction per osteotomy and duration of GFI ( P =0.12). Postoperative complications at 2 years were similar (PCO=25% vs. no PCO=27%, P =0.63).
Conclusions: EOS graduates achieve minimal correction at time of conversion regardless of whether PCOs are performed. PCOs increase EBL and operative time but have a similar complication rate. More PCOs resulted in more correction, though less than that anticipated in a previously uninstrumented spine.
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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.
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