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IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal Pub Date : 2025-02-22 DOI:10.1016/j.spinee.2025.02.002

Liu Zhen, Tang Ziyang, Li Jie, Hu Zongshan, Qin Xiaodong, Shi Benlong, Mao Saihu, Qiu Yong, Zhu Zezhang

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引用次数: 0

摘要

背景情况：近端交界性脊柱后凸（PJK）是退行性脊柱后凸（DKS）畸形矫正的常见并发症，发生率在 20% 到 40% 之间。目前已提出多种预防 PJK 的技术，但这些技术的临床疗效仍不明确。目的：与对照组相比，在至少 2 年的随访中评估使用 TPS 矫正 DKS 手术的临床效果和机械并发症：患者样本：2020年1月至2022年4月的115例DKS患者：患者报告的结果测量包括SRS-22、ODI、VAS评分。影像学测量包括Cobb角、冠状面平衡距离（CBD）、区域性驼背（RK）和矢状面垂直轴（SVA）：患者分为两组：TPS 组 67 例，对照组 48 例，两组患者均在最颅骨节段使用传统椎弓根螺钉。术前、术后和最后一次随访时均测量了影像学参数。并记录了并发症，包括 PJK、近端连接失败（PJF）和肋间神经痛。PJK 的定义是上器械椎体（UIV）下端板与 UIV + 2（PJA）上端板之间的后凸角度增加 10° 或更多。PJF的定义是：UIV或UIV + 1骨折、需要近端延伸融合或UIV植入失败：结果：两组患者术前的影像学参数无明显差异。术后，两组患者主要曲线的 Cobb 角均有明显改善（TPS 组从 36.7°±20.4° 降至 15.3°±11.5°，对照组从 37.1°±16.0° 降至 16.8°±9.0°，P 0.05）。两组患者的健康相关生活质量（HRQoL）评分均有明显改善，包括 SRS-22、ODI 评分（TPS 组从 46.5±16.2 降至 21.3±13.2；对照组从 44.7±18.6 降至 23.8±16.4；P＜0.05）和 VAS（TPS 组从 6.5±2.2 降至 2.1±1.6；对照组从 6.0±2.9 降至 2.3±2.2；P＜0.05）。在随访期间，TPS 组有 2 名患者（3.0%）出现了 PJK，而对照组有 13 名患者（27.1%）出现了 PJK：在最颅骨节段采用 TPS 固定技术进行 DKS 手术矫正可获得令人满意的临床效果，且发生 PJK 的风险较低。不过，这种方法引起肋间神经痛的风险较高，可能是螺钉刺激神经根所致。

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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Tri-cortical Pedicle Screw Fixation in the Most Cranial Instrumented Segment to Prevent Proximal Junctional Kyphosis.

Background context: Proximal junctional kyphosis (PJK) is a common complication of deformity correction for degenerative kyphoscoliosis (DKS) with an incidence between 20% and 40%. Multiple techniques have been proposed to prevent PJK, however, the clinical efficacy of these techniques remains unclear. Here, we investigate the influence of thoracic tri-cortical pedicle screw (TPS) in the most cranial instrumented segment on PJK.

Purpose: To evaluate the clinical outcomes and mechanical complications in corrective surgery for DKS at a minimum 2-year follow-up using TPS compared to a control group.

Study design: Retrospective study PATIENT SAMPLE: 115 patients with DKS from January 2020 to April 2022 OUTCOME MEASURE: Patient reported outcome measures included: SRS-22, ODI, VAS scores. Radiographic measures included: Cobb angle, coronal balance distance (CBD), regional kyphosis (RK), and sagittal vertical axis (SVA).

Methods: Patients were divided into two groups: 67 patients in TPS group and 48 patients who with traditional pedicle screws in the most cranial instrumented segment in control group. The radiographic parameters were measured pre-, post-operative period, and at the last follow-up. Complications, including PJK, proximal junctional failure (PJF), and intercostal neuralgia were recorded. PJK was defined as: 10° or higher increase in kyphosis angle which between the inferior endplate of upper instrumented vertebra (UIV) and the superior endplate of the UIV + 2 (PJA). PJF was defined as: fracture of UIV or UIV + 1, need for proximal extension of fusion, or implant failure of UIV.

Results: There was no significant difference in pre-operative radiographic parameters between two groups. After surgery, the Cobb angle of the major curve improved significantly in both groups (36.7°±20.4° to 15.3°±11.5° in TPS group, 37.1°±16.0° to 16.8°±9.0° in control group, P<0.001). Significant improvements in RK, CBD, and SVA were observed after surgery, and no loss of correction was found during follow-up (P > 0.05). Patients in both groups had significant improvement in health-relative quality of life (HRQoL) scores, including SRS-22, ODI score (46.5±16.2 to 21.3±13.2 in TPS group; 44.7±18.6 to 23.8±16.4 in control group; P < 0.05), and VAS (6.5±2.2 to 2.1±1.6 in TPS group; 6.0±2.9 to 2.3±2.2 in control group; P < 0.05). During the follow-up period, two patients in TPS group developed PJK (3.0%), compared to 13 patients in the control group (27.1%) (P<0.001). Notably, 5 patients in TPS group developed intercostal neuralgia which was not observed in control group, though all had full recovery following conservative treatment during three weeks.

Conclusion: TPS fixation technique at the most cranial segment can produce satisfactory clinical outcomes in the surgical correction of DKS with a lower risk of PJK. However, it does incur a higher risk for intercostal neuralgia, likely from nerve root irritation from the screw.

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来源期刊

Spine Journal 医学-临床神经学

CiteScore

8.20

自引率

6.70%

发文量

680

审稿时长

13.1 weeks

期刊介绍： The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations. It is a condition of publication that manuscripts submitted to The Spine Journal have not been published, and will not be simultaneously submitted or published elsewhere. The Spine Journal also publishes major reviews of specific topics by acknowledged authorities, technical notes, teaching editorials, and other special features, Letters to the Editor-in-Chief are encouraged.