Incidence of the Crankshaft Phenomenon in Thoracic Congenital Early-Onset Scoliosis Patients Followed Until Skeletal Maturity.

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY Neurosurgery Pub Date : 2025-04-04 DOI:10.1227/neu.0000000000003429

Guanfeng Lin, Chenkai Li, You Du, Yiwei Zhao, Shengru Wang, Yang Yang, Nan Wu, Qianyu Zhuang, Jianxiong Shen, Jianguo Zhang

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Abstract

Background and objectives: Patients who undergo posterior spinal fusion (PSF) surgery before puberty are at high risk of experiencing the crankshaft phenomenon. Currently, there are no studies reporting the incidence of crankshaft phenomenon in a highly homogeneous cohort of patients with thoracic congenital early-onset scoliosis (CEOS) who were followed up to skeletal maturity. The aim of this study was to reveal the real incidence and identify the risk factors associated with the crankshaft phenomenon in CEOS patients who underwent pedicle screw fixation and PSF before the pubertal growth spurt and to explore surgical strategies aimed to prevent this phenomenon.

Methods: Patients who underwent pedicle screw fixation and PSF before the pubertal growth spurt and were followed up until skeletal maturity were enrolled. Coronal and sagittal radiological parameters were evaluated before surgery, immediately after surgery and at the final follow-up. The incidence and risk factors of the crankshaft phenomenon were evaluated according to different parameters.

Results: Eighty-one patients (31 men and 50 women) were enrolled, with a mean follow-up time of 97.36 ± 33.03 months (60-192 months). The mean age was 7.24 ± 2.53 years (2-10 years) preoperatively and 15.40 ± 2.07 years (14-25 years) at the last follow-up. The overall incidence of the crankshaft phenomenon was 32.10% (26/81), and 12 of the patients (46.15%) required revision surgery. The incidence of the crankshaft phenomenon significantly increased with the age 5 years and younger (odds ratio = 3.402, P = .038) and number of fused segments <5 (odds ratio = 3.662, P = .028).

Conclusion: The incidence of the crankshaft phenomenon may have been underestimated before this point, and skeletal maturity could determine the real incidence of the crankshaft phenomenon. The incidence could be as high as 32.10% in thoracic CEOS populations. A younger age (≤5 years old) and short segmental fusion (<5 segments) can help predict the crankshaft phenomenon in thoracic CEOS patients.

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胸部先天性早发脊柱侧弯症患者曲轴现象的发生率，随访至骨骼成熟。

背景和目的：在青春期前接受脊柱后路融合（PSF）手术的患者极有可能出现曲轴现象。目前，还没有研究报告在高度同质的胸椎先天性早发脊柱侧凸（CEOS）患者群中随访至骨骼成熟期的曲轴现象发生率。本研究的目的是揭示在青春期发育高峰前接受椎弓根螺钉固定和PSF手术的先天性脊柱侧凸患者中曲轴现象的实际发生率，确定与之相关的风险因素，并探讨旨在预防这种现象的手术策略：入选患者均在青春期发育高峰前接受了椎弓根螺钉固定和PSF手术，并随访至骨骼发育成熟。对术前、术后即刻和最后随访的冠状位和矢状位放射学参数进行了评估。根据不同的参数评估了曲轴现象的发生率和风险因素：81 名患者（31 名男性和 50 名女性）接受了手术，平均随访时间为 97.36 ± 33.03 个月（60-192 个月）。术前平均年龄为 7.24 ± 2.53 岁（2-10 岁），最后一次随访时平均年龄为 15.40 ± 2.07 岁（14-25 岁）。曲轴现象的总发生率为32.10%（26/81），其中12名患者（46.15%）需要进行翻修手术。曲轴现象的发生率随着年龄的增长而明显增加，年龄在5岁及以下（几率比=3.402，P=0.038），融合节段的数量也明显增加结论：曲轴现象的发生率随着年龄的增长而明显增加（几率比=3.402，P=0.038），融合节段的数量也明显增加：在此之前，曲轴现象的发生率可能被低估了，骨骼的成熟度可以决定曲轴现象的实际发生率。胸椎 CEOS 患者的发病率可能高达 32.10%。较小的年龄（≤5 岁）和较短的节段融合（≤5 岁）可能会导致曲轴现象的发生。

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来源期刊

Neurosurgery 医学-临床神经学

CiteScore

8.20

自引率

6.20%

发文量

898

审稿时长

2-4 weeks

期刊介绍： Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.