Xiongjie Li, Yong-Chan Kim, Sung-Min Kim, Billy Francis Hung, Young-Jik Lee
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引用次数: 0
Abstract
Objective: This study aimed to provide a method for determining the apical vertebra for pedicle subtraction osteotomy (PSO) in corrective surgery for patients with ankylosing spondylitis (AS) with thoracolumbar kyphosis (TLK).
Methods: The medical records of AS patients with TLK who underwent PSO between May 2009 and August 2022 were retrospectively reviewed, and 235 patients were included in the study. Using the proposed method, choosing the vertebra based on Kim's apex (KA), which is defined as the farthest vertebra from a line drawn from the center of the T10 vertebral body to the midpoint of the S1 upper endplate, the authors analyzed 229 patients with apices at T12, L1, or L2 (excluding L3 because of the small sample size, n = 6). They divided all patients into two groups. Group A (n = 144) underwent PSO at the KA vertebra, while group B (n = 85) underwent PSO at a different level. Demographic and radiological data, including sagittal spinopelvic parameters of the entire spine, were collected. An additional analysis was performed on patients with the same KA vertebra.
Results: The vertebra distributions of patients based on KA were T12 (28 [12.2%]), L1 (119 [52.0%]), and L2 (82 [35.8%]). The corrections of sagittal vertical axis (SVA; 101.0 ± 48.5 mm vs 82.0 ± 53.8 mm, p = 0.010), global kyphosis (GK; 31.6° ± 10.0° vs 26.4° ± 10.5°, p = 0.005), and TLK (29.4° ± 10.2° vs 24.2° ± 12.9°, p = 0.012) in group A were significantly greater than those in group B, and there was no difference in the corrections of thoracic kyphosis (TK), lumbar lordosis, and pelvic incidence between the two groups. On further analysis, group A showed greater correction in TK (26.2° ± 13.7° vs 0.1° ± 8.1°, p = 0.013) for patients with T12 as the KA; greater improvements in SVA (101.5 ± 44.2 mm vs 73.4 ± 48.7 mm, p = 0.020), GK (30.6° ± 11.0° vs 25.0° ± 10.4°, p = 0.046), and TLK (32.6° ± 7.8° vs 26.7° ± 9.9°, p = 0.012) for those with L1 as the KA; and significant correction in TLK (30.0° ± 6.3° vs 4.3° ± 19.5°, p = 0.008) for patients with L2 as the KA, compared with group B.
Conclusions: PSO at the apical vertebra provides a greater degree of correction of sagittal imbalance. The proposed method, selecting the vertebra based on KA, is easily reproducible for determining the apex level in AS patients with TLK.
研究目的本研究旨在为强直性脊柱炎(AS)伴胸腰椎后凸(TLK)患者的矫正手术中确定椎弓根截骨(PSO)的顶椎提供一种方法:回顾性分析2009年5月至2022年8月期间接受PSO手术的强直性脊柱炎伴TLK患者的病历,共纳入235例患者。作者采用提议的方法,根据金氏顶点(KA)(定义为从T10椎体中心到S1上终板中点的直线上最远的椎体)选择椎体,分析了229例顶点位于T12、L1或L2的患者(由于样本量较小,不包括L3,n = 6)。他们将所有患者分为两组。A 组(n = 144)在 KA 椎进行 PSO,而 B 组(n = 85)在不同水平进行 PSO。收集了人口统计学和放射学数据,包括整个脊柱的矢状脊柱参数。另外还对KA椎体相同的患者进行了分析:基于 KA 的患者椎体分布为 T12(28 [12.2%])、L1(119 [52.0%])和 L2(82 [35.8%])。矢状垂直轴(SVA;101.0 ± 48.5 mm vs 82.0 ± 53.8 mm,P = 0.010)、整体后凸(GK;31.6° ± 10.0° vs 26.4° ± 10.5°,P = 0.005)和 TLK(29.4° ± 10.2° vs 24.2° ± 12.A组的胸椎后凸(TK)、腰椎前凸和骨盆前倾的矫正率没有差异。进一步分析显示,A 组以 T12 为 KA 的患者的 TK 矫正幅度更大(26.2°±13.7° vs 0.1°±8.1°,p = 0.013);SVA(101.5±44.2 mm vs 73.4±48.7 mm,p = 0.020)、GK(30.6°±11.0° vs 25.0°±10.4°,p = 0.043)、SVA(101.5±44.2 mm vs 73.4±48.7 mm,p = 0.020)、GK(30.6°±11.0° vs 25.0°±10.4°,p = 0.043)的改善幅度更大。4°,p = 0.046)和 TLK(32.6°±7.8° vs 26.7°±9.9°,p = 0.012);与 B 组相比,以 L2 为 KA 的患者的 TLK(30.0°±6.3° vs 4.3°±19.5°,p = 0.008)显著矫正:结论:顶椎的 PSO 能更大程度地矫正矢状面失衡。所提出的根据 KA 选择椎体的方法在确定 TLK AS 患者的顶点水平时易于重复。
期刊介绍:
Primarily publish original works in neurosurgery but also include studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology.