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Abstract：
Background: This study aimed to compare the incidence and severity of cervical kyphosis before and after surgery between patients with adolescent idiopathic scoliosis (AIS) with major thoracolumbar/lumbar curves (Lenke type 5C group) and those with major thoracic curves (Lenke type 1A group). Further, factors associated with cervical spinal alignment changes after surgery in the two groups were examined. Methods: This study included consecutive patients with AIS who underwent posterior spinal fusion for Lenke type 1A and 5C curves and who were followed up for at least 1 year. To measure changes in sagittal alignment, all patients underwent radiography before, immediately after, and at 1 year after surgery. The correlation coefficients change the value of the C2-C7 angle before and after surgery (ΔC2-ΔC7) and other spinopelvic parameters were examined. Results: In total, 19 of 30 patients in the Lenke type 1A group and 21 of 36 in the Lenke type 5C group presented with cervical kyphosis preoperatively. Hence, the incidence of cervical kyphosis did not significantly differ between the two groups. Further, the two groups had significantly higher thoracic kyphosis (TK) and greater C2-C7 angles postoperatively. The TK of the Lenke type 5C group further increased at 1 year postoperatively. The Lenke 1A type group presented with a significant re-decrease in the C2-C7 angle at 1 year postoperatively. However, the C2-C7 angle of the Lenke type 5C group did not change. The ΔTK was closely associated with the ΔC2-ΔC7 in the Lenke type 1A group, but not in the Lenke type 5C group. Conclusions: In thoracic AIS, postoperative cervical alignment should achieve an adequate TK and promote correction of the coronal plane curve. Moreover, selective corrective surgery can improve postoperative cervical alignment in lumbar AIS.
摘要：
背景：本研究旨在比较青少年特发性脊柱侧凸（AIS）伴主要胸腰椎/腰椎曲线（Lenke型5C组）和主要胸腰椎曲线（Lenke型1A组）患者手术前后颈椎后凸的发生率和严重程度。Further,研究了两组患者手术后颈椎排列变化的相关因素。方法：这项研究包括连续的AIS患者，他们接受了Lenke型1A和5C曲线的后路脊柱融合术，并随访了至少1年。要测量矢状对齐的变化，所有患者之前都接受了X线摄影，紧接着,手术后1年。相关系数改变了手术前后C2-C7角度的值（ΔC2-ΔC7），并检查了其他脊柱骨盆参数。结果：总的来说，Lenke型1A组30例患者中的19例和Lenke型5C组36例患者中的21例术前出现颈椎后凸畸形。因此，宫颈后凸畸形的发生率在两组间无显著差异.Further,两组术后胸椎后凸(TK)明显增高,C2-C7角度增大.Lenke型5C组的TK在术后1年进一步增加。Lenke1A型组术后1年C2-C7角显着降低。然而,Lenke型5C组的C2-C7角度没有改变。在Lenke1A型组中，ΔTK与ΔC2-ΔC7密切相关，但不是Lenke型5C组。结论：在胸部AIS中，术后颈椎对齐应达到足够的TK并促进冠状平面曲线的矫正.此外，选择性矫正手术可以改善腰椎AIS术后颈椎对位。
