Bipolar hybrid posterior instrumentation tecnique for the correction of Scheuermann's kyphosis.

IF 1.6 Q3 CLINICAL NEUROLOGY Spine deformity Pub Date : 2024-11-01 Epub Date: 2024-07-18 DOI:10.1007/s43390-024-00928-6
María Coro Solans Lopez, Jose María Hernández Mateo, Alejandro Barrios Ayuso, Cristina Igualada Blázquez, Tania Quevedo Narciso, Azucena García Martín, Oscar Gabriel Riquelme García, Luis Alejandro Esparragoza Cabrera
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Abstract

Scheuermann´s kyphosis (SK) is the most common cause of painful and progressive structural hyperkyphosis in adolescents. Surgical treatment should be considered in cases of refractory pain or progressive deformities. We present the clinical and radiological results obtained using a bipolar, hybrid posterior instrumentation tecnique. We analysed 12 males and 6 females, with mean age of 15.8 years. Minimum follow-up was 2 years. We used transverse process hooks at the cranial level and polyaxial screws for the remaining levels. We did not instrument the periapical segment. We used the sagittal stable vertebra (SSV) as the lower instrumented vertebra (LIV) in most cases, the "barely touched SSV" if the above disc space is lordotic. The mean preoperative kyphosis was 73.6º, mean postoperative kyphosis 44.7º, and mean correction of 28.9º (p = 0.0002). The mean reduction in lumbar lordosis (LL) was 8.9º (p = 0.0018). There were no significant differences in the spinopelvic parameters or sagittal balance. The mean number of instrumented levels was 8.9. Type II osteotomies were necessary in only three patients. Three patients had a cranial sagittal angle greater than 10°, all of them asymptomatic. Postoperatively, all patients had VAS scores less than 2 and SRS-22 scores greater than 4. Hybrid bipolar posterior instrumentation offers adequate curve correction, less operative time, implant density, bleeding, material protrusion and risk of spinal cord injury, leaving a large periapical bed for graft supply. We propose to measure the flexibility of the curve in MRI. In flexible curves (those that correct at least 20% in the supine decubitus position), wide facetectomies offer adequate correction of the deformity.

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用于矫正谢尔曼后凸的双极混合后方器械技术。
谢尔曼氏脊柱后凸(SK)是导致青少年疼痛和进行性结构性脊柱后凸的最常见原因。对于难治性疼痛或进行性畸形,应考虑手术治疗。我们介绍了使用双极混合后路器械技术获得的临床和放射学结果。我们对 12 名男性和 6 名女性进行了分析,他们的平均年龄为 15.8 岁。最短随访时间为 2 年。我们在颅骨水平使用了横突钩,在其余水平使用了多轴螺钉。我们没有在根尖周围使用器械。在大多数病例中,我们使用矢状稳定椎体(SSV)作为下部器械椎体(LIV),如果椎间盘间隙上方有前凸,则使用 "勉强触及的SSV"。术前的平均后凸度为 73.6º,术后的平均后凸度为 44.7º,平均矫正度为 28.9º(P = 0.0002)。腰椎前凸(LL)平均减少了 8.9º(p = 0.0018)。脊柱骨盆参数和矢状平衡无明显差异。平均器械水平数为 8.9。只有三名患者需要进行 II 型截骨。三名患者的头颅矢状角大于 10°,均无症状。术后,所有患者的 VAS 评分均小于 2 分,SRS-22 评分均大于 4 分。 混合双极后路器械治疗可提供充分的曲线矫正,减少手术时间、种植体密度、出血、材料突出和脊髓损伤的风险,并为移植物供应留出较大的根尖周床。我们建议通过核磁共振成像来测量曲线的柔韧性。对于灵活的曲线(在仰卧位至少矫正 20% 的曲线),宽面切除术可充分矫正畸形。
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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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