Clinical and radiological outcomes of gradual reduction and circumferential fusion of high-grade spondylolisthesis in adolescents: a prospective cohort study of 29 young patients.

IF 1.6 Q3 CLINICAL NEUROLOGY Spine deformity Pub Date : 2024-09-01 Epub Date: 2024-05-02 DOI:10.1007/s43390-024-00884-1
Antoine Dionne, Jean-Marc Mac-Thiong, Stefan Parent, Jesse Shen, Julie Joncas, Soraya Barchi, Hubert Labelle
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Abstract

Aim: The objective of this study was to evaluate the safety and efficacy of a novel technique of formal reduction and circumferential fusion for pediatric high-grade spondylolisthesis (HGS).

Purpose: The safety and efficacy of formal reduction for high-grade spondylolisthesis (HGS) has never been thoroughly examined. This study reports the outcomes of 29 children with HGS who underwent a procedure of gradual reduction and circumferential fusion.

Methods: 29 children (13 males, 16 females) were recruited between 2006 and 2010. Radiographic measurements (including % of slip, lumbosacral angle-LSA, pelvic incidence-PI, pelvic tilt-PT, sacral slope-SS, and proximal femoral angle-PFA) and quality of life assessment (SRS-22 questionnaire) were prospectively obtained at baseline and at the last post-operative follow-up (> 2 years post-op). Radiological measurements were used to classify patients according to the Spine Deformity Study Group (SDSG) classification.

Results: Mean baseline slip % was 69.9 ± 16.5%. There were 13 patients with a balanced pelvic (SDSG Type 4) and 16 with an unbalanced pelvis (SDSG Type 5 and 6). On average, a reduction of 45.5 ± 15.3% (range 20-86%) was achieved safely with no major complication. In particular, of the 29 patients, only 3 had a L5 radiculopathy postoperatively that was self-resolved at follow-up. From a radiological standpoint, we observed a mean improvement of LSA from 80.3 ± 17.9° to 91.7 ± 13.6°. We also observed a statistically significant improvement in global HRQOL, and in the function and body image domains.

Conclusion: This prospective study suggests that formal reduction of HGS followed by circumferential fusion is safe when using a standardized surgical technique based on gradual reduction. Performing this intervention could also help improve QOL in some patients.

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青少年高位脊柱滑脱症渐进缩窄和环形融合术的临床和放射学疗效:对 29 名年轻患者进行的前瞻性队列研究。
目的:对高位脊柱滑脱症(HGS)进行正规缩窄术的安全性和有效性从未进行过深入研究。本研究报告了 29 名接受渐进缩窄和环形融合术的 HGS 患儿的治疗结果。方法:2006 年至 2010 年间招募了 29 名患儿(13 名男性,16 名女性)。在基线和术后最后一次随访(术后 2 年以上)时进行了放射学测量(包括滑脱率、腰骶角-LSA、骨盆内陷-PI、骨盆倾斜-PT、骶骨斜度-SS 和股骨近端角-PFA)和生活质量评估(SRS-22 问卷)。根据脊柱畸形研究小组(SDSG)的分类方法,采用放射学测量对患者进行分类:平均基线滑移率为 69.9 ± 16.5%。有 13 名患者骨盆平衡(SDSG 4 型),16 名患者骨盆不平衡(SDSG 5 型和 6 型)。平均而言,手术安全地缩小了 45.5 ± 15.3%(范围为 20-86%),没有出现重大并发症。特别值得一提的是,在 29 名患者中,只有 3 名患者术后出现了 L5 根性病变,但在随访时已自行缓解。从放射学角度来看,我们观察到 LSA 的平均值从 80.3 ± 17.9° 提高到 91.7 ± 13.6°。我们还观察到,患者的总体 HRQOL 以及功能和身体形象方面都有了统计学意义上的显著改善:这项前瞻性研究表明,在使用基于渐进缩窄的标准化手术技术时,正式缩窄 HGS 后进行周缘融合是安全的。进行这种干预还有助于改善部分患者的 QOL。
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来源期刊
CiteScore
3.20
自引率
18.80%
发文量
167
期刊介绍: Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.
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