{"title":"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。","authors":"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","doi":"10.1007/s43390-024-01005-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Investigate zones where implant density should not be reduced in posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) Lenke type 1A curves.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Zones where reduced implant density leads to correction loss after scoliosis surgery for Lenke 1A adolescent idiopathic scoliosis: a multicenter study.\",\"authors\":\"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\",\"doi\":\"10.1007/s43390-024-01005-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Investigate zones where implant density should not be reduced in posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) Lenke type 1A curves.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":21796,\"journal\":{\"name\":\"Spine deformity\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-11-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spine deformity\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s43390-024-01005-8\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine deformity","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s43390-024-01005-8","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Zones where reduced implant density leads to correction loss after scoliosis surgery for Lenke 1A adolescent idiopathic scoliosis: a multicenter study.
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.
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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