PDF(Pubmed)
Abstract：
Background/Objectives: Anterior spinal fusion for primary thoracolumbar or lumbar (TL/L) adolescent idiopathic scoliosis, AIS, has advantages over posterior fusion, particularly in saving motion segments below the fusion construct. Traditionally, the approach is anterolaterally from the convexity. In adult degenerative scoliosis, the lateral or anterolateral approach may be performed from the traditional or from the concave approach which is less invasive and gives comparable outcomes. The purpose of the present pilot study was to assess the feasibility of the less invasive concave approach for younger AIS patients and compare it to the traditional convex approach over a 5-year follow-up period. Methods: The two cohorts were assessed by comparing pre- to postoperative radiographs, and clinical outcomes for pain, function, self-perception of appearance, and opinion of surgical success were prospectively obtained. Results: Radiographs found that primary TL/L scoliosis significantly improved from 53° to 18° (65%) for both the concave and convex cohorts. Sagittal alignments remained stable and there was no difference between cohorts. Coronal balance improved in both cohorts and sagittal balance was stable for both. Clinically, VAS back pain improved significantly for both cohorts initially and remained improved in the concave group. Leg pain, pain drawing, ODI disability, and VAS appearance scores improved and there was no difference between cohorts. The self-rating of success of the procedure was 100% at early and late follow-up periods. There were no neurological/surgical complications. Conclusions: The concave approach for anterior fusion for TL/L AIS is feasible with comparable radiographic and clinical outcomes to the traditional approach.
摘要：
背景/目的:前路脊柱融合术治疗原发性胸腰椎或腰椎(TL/L)青少年特发性脊柱侧凸,AIS,优于后路融合，特别是在融合结构下面保存运动段。传统上,该方法是从凸性向前。在成人退行性脊柱侧弯中，外侧或前外侧入路可从传统入路或从侵入性较小的凹面入路进行,并可获得相当的结果.本试点研究的目的是评估年轻AIS患者侵入性较小的凹入法的可行性，并将其与传统的凸入法进行5年随访。方法：通过比较术前和术后的X线照片来评估两个队列，和疼痛的临床结果，函数,自我感知的外观，并前瞻性地获得了手术成功的意见。结果：放射学发现，对于凹和凸两个队列，原发性TL/L脊柱侧凸从53°显着改善至18°（65％）。矢状排列保持稳定，队列之间没有差异。两组的冠状平衡均得到改善，矢状平衡均稳定。临床上,最初两个队列的VAS背痛均有显着改善，而在凹形组中仍有改善。腿部疼痛,疼痛绘画，ODI残疾，VAS外观评分改善,且队列间无差异.在早期和晚期随访期间，该程序成功的自我评估为100％。没有神经/手术并发症。结论：凹入路用于TL/LAIS的前路融合是可行的，具有与传统入路相当的影像学和临床效果。
