一项国际多中心研究:在复杂的儿童畸形中,使用亚轴颈椎椎弓根螺钉穿过颈胸连接处以维持结构完整性。

IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY
David B Kurland, Ritt R Givens, Alondra Concepción-González, Alexander Eremiev, Yosef Dastagirzada, Nikita Alexiades, Benjamin D Roye, Michael G Vitale, Richard C E Anderson
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引用次数: 0

摘要

目的:在复杂的小儿脊柱畸形病例中,可能需要后路脊柱内固定穿过颈胸交界处(CTJ)。这是最常见的翻修手术,以解决近端关节后凸(PJK)。在颈椎中,侧块螺钉是最常用的,尽管它们可能导致生物力学薄弱的近端结构和易发生内固定失败。最近有报道称,使用辅助前路构造具有良好的效果,但这需要额外的外科手术。下颈椎椎弓根螺钉无需前路入路即可提供良好的生物力学固定,但结果数据非常有限。本研究的目的是评估使用下颈椎椎弓根螺钉穿过CTJ进行后路脊柱内固定融合(PSIF)的儿科患者两年后的影像学和临床结果。方法:对儿童脊柱研究组(PSSG)注册表进行查询,以确定≤21岁的患者,这些患者通过至少两年的临床和影像学随访进行PSIF穿越CTJ。如果患者有前路稳定史,或者他们的椎弓根下螺钉融合结构从C6以下开始,则排除。评估临床、手术和放射学参数,并对测量结果进行统计比较。结果:符合纳入标准的患者8例(女6例,男2例),平均手术年龄11.2±3.3岁。所有患者均行PSIF穿过CTJ(平均融合水平15.6±6.6)。下颈椎椎弓根螺钉的平均密度为61.9%±27.8(范围28.5 ~ 100%)。主冠状面曲线术前平均54.7°±19.6,术后平均34.5°±13.6(矫正41.5%±26.5;p = 0.03)。平均主矢状面曲线术前为55.9°±20.6°,术后矫正为29.6°±9.6°(44.2%±18.0);P = 0.01)。术中、术后均无重大并发症。在至少2年的随访中,8/8例患者的畸形参数保持稳定,没有PJK的影像学证据。结论:在这个小型的初步国际脊柱畸形儿童系列研究中,在跨越颈胸连接处的构造物中纳入亚轴颈椎椎弓根螺钉可获得良好的临床和影像学结果,无重大并发症。下颈椎椎弓根螺钉提供了增强的生物力学稳定性,并可能消除对儿科患者额外的前路支持的需要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Maintenance of construct integrity with subaxial cervical pedicle screws when crossing the cervicothoracic junction in complex pediatric deformity: an international multicenter study.

Objective: In cases of complex pediatric spinal deformity, posterior spinal instrumentation crossing the cervicothoracic junction (CTJ) may be required. This is most frequently encountered for revision surgery to address proximal junctional kyphosis (PJK). In the cervical spine, lateral mass screws are most commonly used, although they may result in biomechanically weak proximal constructs and predispose to instrumentation failure. The use of supplemental anterior constructs has recently been reported with promising results, but this necessitates an additional surgical procedure. Subaxial cervical pedicle screws can provide good biomechanical fixation without the need for an anterior approach, but outcome data have been very limited. The purpose of this study was to assess radiographic and clinical outcomes at two years in pediatric patients who have undergone posterior spinal instrumentation and fusion (PSIF) crossing the CTJ using subaxial cervical spine pedicle screws.

Methods: The Pediatric Spine Study Group (PSSG) registry was queried to identify patients ≤ 21 years old who underwent PSIF crossing the CTJ with two-year minimum clinical and radiographic follow-up. Patients were excluded if they had a history of anterior stabilization or if their fusion construct with subaxial pedicle screws started below C6. Clinical, surgical, and radiographic parameters were assessed, and measurements were compared statistically.

Results: Then, 8 patients (6 female and 2 male) met inclusion criteria, with a mean age at surgery of 11.2 ± 3.3 years. All patients underwent PSIF crossing the CTJ (mean levels fused 15.6 ± 6.6). The mean density of subaxial cervical pedicle screws was 61.9% ± 27.8 (range 28.5 to 100%). The major coronal curve averaged 54.7° ± 19.6 preoperatively and 34.5° ± 13.6 postoperatively (41.5% ± 26.5 correction; p = 0.03). The average major sagittal curve was 55.9° ± 20.6 preoperatively and 29.6° ± 9.6 (44.2% ± 18.0 correction; p = 0.01) postoperatively. There were no major intraoperative or postoperative complications. Deformity parameters remained stable without radiographic evidence of PJK in 8/8 patients at minimum 2-year follow-up.

Conclusions: In this small preliminary international series of pediatric patients with spinal deformity, the inclusion of subaxial cervical pedicle screws in constructs that span the cervicothoracic junction resulted in good clinical and radiographic outcomes without major complications. Subaxial cervical spine pedicle screws provide enhanced biomechanical stability and may eliminate the need for additional anterior support in pediatric patients.

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来源期刊
Child's Nervous System
Child's Nervous System 医学-临床神经学
CiteScore
3.00
自引率
7.10%
发文量
322
审稿时长
3 months
期刊介绍: The journal has been expanded to encompass all aspects of pediatric neurosciences concerning the developmental and acquired abnormalities of the nervous system and its coverings, functional disorders, epilepsy, spasticity, basic and clinical neuro-oncology, rehabilitation and trauma. Global pediatric neurosurgery is an additional field of interest that will be considered for publication in the journal.
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