Zones where reduced implant density leads to correction loss after scoliosis surgery for Lenke 1A adolescent idiopathic scoliosis: a multicenter study.

IF 1.6 Q3 CLINICAL NEUROLOGY Spine deformity Pub Date : 2024-11-11 DOI:10.1007/s43390-024-01005-8

Kaho Yanagisawa, Hiroki Oba, Tetsuro Ohba, Tomohiro Banno, Shoji Seki, Masashi Uehara, Shota Ikegami, Tetsuhiko Mimura, Terue Hatakenaka, Yoshinari Miyaoka, Daisuke Kurogochi, Takuma Fukuzawa, Michihiko Koseki, Yoshiharu Kawaguchi, Hirotaka Haro, Yukihiro Matsuyama, Jun Takahashi

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Abstract

Purpose: Investigate zones where implant density should not be reduced in posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) Lenke type 1A curves.

Methods: 126 consecutive patients (118 female and 8 male; mean age: 15.1 ± 2.2 years) with Lenke type 1A AIS who underwent PSF using pedicle screw constructs were included. Correction loss which was calculated using immediately postoperative and 2-year postoperative Cobb angle. Implant density was assessed by dividing the instrumented levels into four zones each on the concave and convex sides. The risk factors for significant correction loss were examined using logistic regression analysis. For convex apical zone, correction loss was compared among the three groups of low (0-59%), medium (60-99%), and high (100%) implant density.

Results: Multivariate analysis revealed the apical zone of the convex side (Odds ratio [OR] 1.27; 95% confidence interval [CI] 1.01-1.59; P = 0.04) and the peri-apical zone of the convex side (OR 1.33; 95% CI 1.11-1.59; P = 0.002) as independent predictors of significant correction loss. In the convex apical zone, the median (interquartile range) correction loss of the low implant density, medium implant density, and high implant-density groups was 4.8° (1.5°), 5.3° (0.8°), and 2.2° (0.3°), respectively. The median difference was 2.6° (P = 0.048) between the low implant density and high implant-density group and 3.1° (P < 0.001) between the medium implant density and high implant-density group.

Conclusion: In PSF for AIS Lenke 1A, low implant density in the convex apical zones were significant factors affecting correction loss at 2 years postoperatively. However, the difference in correction loss between groups may not be large enough to consider clinically meaningful. Prospective studies of longer term outcomes are needed to determine whether these results are clinically important.

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Lenke 1A 青少年特发性脊柱侧凸手术后植入物密度降低导致矫正损失的区域：一项多中心研究。

目的：调查青少年特发性脊柱侧凸（AIS）Lenke 1A 型曲线后路脊柱融合术（PSF）中植入物密度不应降低的区域。方法：纳入 126 例连续接受 PSF 手术的 Lenke 1A 型 AIS 患者（女性 118 例，男性 8 例；平均年龄：15.1 ± 2.2 岁），他们均使用椎弓根螺钉结构。使用术后即刻和术后 2 年的 Cobb 角计算矫正损失。通过将植入器械的水平面分为凹面和凸面各四个区域来评估植入密度。采用逻辑回归分析法研究了造成明显矫正损失的风险因素。就凸面根尖区而言，对低种植体密度（0-59%）、中种植体密度（60-99%）和高种植体密度（100%）三组的矫正损失进行了比较：多变量分析显示，凸侧根尖区（Odds ratio [OR] 1.27; 95% confidence interval [CI] 1.01-1.59; P = 0.04）和凸侧根尖周围区（OR 1.33; 95% CI 1.11-1.59; P = 0.002）是显著矫正损失的独立预测因素。在凸尖区，低种植体密度组、中种植体密度组和高种植体密度组的矫正损失中位数（四分位间范围）分别为 4.8° (1.5°)、5.3° (0.8°) 和 2.2° (0.3°)。低种植体密度组与高种植体密度组之间的中位数差异为 2.6°（P = 0.048），高种植体密度组为 3.1°（P 结论：低种植体密度组与高种植体密度组之间的中位数差异为 2.6°（P = 0.048）：在针对 AIS Lenke 1A 的 PSF 中，术后 2 年时，根尖凸区种植体密度低是影响矫正损失的重要因素。然而，各组间矫正损失的差异可能还不够大，因此没有临床意义。要确定这些结果是否具有临床意义，还需要对长期结果进行前瞻性研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine deformity

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.