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Distal Fusion Level Selection in Scheuermann’s Kyphosis: A Comparison of Lordotic Disc Segment Versus the Sagittal Stable Vertebrae

机译:Scheuermann脊柱后凸的远端融合水平选择:椎间盘段与矢状稳定椎骨的比较

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Study Design: Retrospective study. Objective: To compare 2 methods of selecting the lowest instrumented vertebra (LIV) on the rates of revision surgery for distal junctional kyphosis (DJK) following treatment for Scheuermann’s kyphosis (SK). Methods: A retrospective review of patients who have undergone surgical treatment for SK was performed. Forty-four patients were divided into 2 groups based on intervention: Group 1 (n = 26) included patients who had an LIV distal to or at the sagittal stable vertebrae (SSV), and Group 2 (n = 18) included patients who had an LIV proximal to the SSV. For each group, demographic, radiographic, and revision surgery data was analyzed. Results: The average follow-up was 3.1 years. There were no differences among demographic variables between the groups. Preoperative and postoperative thoracic kyphosis, lumbar lordosis, and sagittal balance were not different between groups. Postoperatively, Group 1 demonstrated a significantly greater average lordotic disc angle below the LIV compared with Group 2 (Group 1, ?6.2 ± 4.3° vs Group 2, ?2.9 ± 5.8°; P = .02). In a subgroup analysis, extending fusions to the sagittal stable vertebra rather than the first lordotic disc resulted in fewer distal LIV complications necessitating revision surgery compared with fusing short of the SSV (5% vs 36.3%, P = .04). Conclusion: The SSV method may reduce complications secondary to distal junctional failure, but at the expense of incorporating additional motion segments in a typically young population.
机译:研究设计:回顾性研究。目的:比较两种选择最低器械椎骨(LIV)的方法对Scheuermann驼背(SK)治疗后远端结节性驼背(DJK)翻修手术的比率。方法:对接受过外科手术治疗SK的患者进行回顾性回顾。根据干预将44例患者分为2组:第1组(n = 26)包括LIV远离或位于矢状稳定椎骨(SSV)的患者,第2组(n = 18)包括患有LIV的患者靠近SSV的LIV。对于每个组,分析了人口统计学,放射照相和翻修手术数据。结果:平均随访时间为3.1年。两组之间的人口统计学变量之间没有差异。两组之间的术前和术后胸椎后凸,腰椎前凸和矢状平衡均无差异。术后1组显示低于LIV的平均脊柱前凸椎间盘角度比第2组显着更大(第1组,第6.2±4.3°,第2组,≤2.9±5.8°; P = .02)。在亚组分析中,与融合少于SSV的情况相比,将融合物扩展到矢状稳定椎体而不是第一块脊柱前凸椎间盘,可以减少远端LIV并发症,因此需要进行翻修手术(5%vs 36.3%,P = .04)。结论:SSV方法可以减少继发于远端交界失败的并发症,但要以在典型的年轻人群中合并其他运动段为代价。

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