背景:患有宫颈或颈胸先天性脊柱侧凸的儿童在补偿畸形的主要曲线的能力方面受到限制,因为他们的颈椎中只有很少的活动节段。多年来,我们经常在这些患者中观察到侧向(从左到右,反之亦然)的冠状寰枢关节脱位(CAAD).预计CAAD可能会补偿头部的水平位置,假设CAAD取决于脊柱侧弯畸形的程度。因此,我们的研究目的是调查这些患者的CAAD与脊柱侧凸参数之间是否存在相关性.
方法:根据CAT扫描和术前X线片对顶点在C4和T6之间的宫颈和颈胸脊柱侧凸患者进行回顾性分析。17名患者,平均年龄为7.25岁,9个女孩和8个男孩,以及在2006年至2022年期间接受治疗的人被包括在内。主曲线的Cobb角(CA-MC),二次曲线的Cobb角(CA-SC),和T1-,在站立位置的全脊柱X光片上测量C2-和UEV(上端椎骨)倾斜。通过冠状CAT扫描重建测量CAAD,并将其定义为侧块到轴中线的距离差。使用SPSS确定Pearson线性相关系数(r),以评估CAAD与测量参数之间的相关性。p<0.05表示有统计学意义。
结果:脊柱侧凸患者通常观察到朝向凸起区域的CAAD;平均CAAD为3mm±3.7mm。平均CA-MC为46°±13°,平均CA-SC为16°±9.6°,平均T1倾角为17°±8.8°,平均C2倾斜为9°±8.8°,平均UEV倾斜度为24°±7.2°。CAAD与CA-MC之间存在较强的线性相关(r=0.784,p<0.001),C2倾斜(r=0.745;p<0.001),和UEV倾斜(r=0.519;p=0.033)。CAAD与CA-SC或T1倾斜之间没有相关性。
结论:患有宫颈或颈胸脊柱侧凸的儿童倾向于具有与CA-MC相关的脊柱侧凸的CAAD,C2-倾斜,和UEV倾斜。CAAD可以被视为将头部保持在水平位置的补偿机制。严重或进展性CAAD可能导致寰枢关节破坏,包括严重的投诉,因此,需要密切随访,并可能早期手术治疗。此外,CAAD可能是在未来的脊柱侧凸研究中检查的有用的其他影像学参数。
BACKGROUND: Children with cervical or cervicothoracic congenital scoliosis are limited in their ability to compensate for the main curve of the
deformity because there are only a few mobile segments in their cervical spine. Over the years, we have frequently observed coronal atlantoaxial dislocation (CAAD) in a lateral direction (from left to right or vice versa) in these patients. It was anticipated that CAAD might compensate for the horizontal position of the head, and it is hypothesized that CAAD depends on the degree of scoliotic
deformity. Thus, the aim of our study was to investigate whether there is a correlation between CAAD and scoliosis parameters in these patients.
METHODS: Retrospective analysis was performed based on CAT scans and preoperative X-rays of patients with cervical and cervicothoracic scoliosis with an apex between C4 and T6. Seventeen patients, with a mean age of 7.25 years, who were 9 girls and 8 boys, and who were treated between 2006 and 2022 were included. Cobb`s angle of the main curve (CA-MC), Cobb`s angle of the secondary curve (CA-SC), and T1-, C2- and UEV (upper end vertebra) tilt were measured on whole-spine radiographs in the standing position. The CAAD was measured via coronal CAT scan reconstruction and defined as the difference in the distances of the lateral masses to the midline of the axis. Pearson`s linear correlation coefficients (r) were determined using SPSS to evaluate correlations between CAAD and the measured parameters. p < 0.05 indicated statistical significance.
RESULTS: CAAD toward the convex region in patients with scoliosis was typically observed; the mean CAAD was 3 mm ± 3.7 mm. The mean CA-MC was 46° ± 13°, the mean CA-SC was 16° ± 9.6°, the mean T1 tilt was 17° ± 8.8°, the mean C2 tilt was 9°± 8.8°, and the mean UEV tilt was 24° ± 7.2°. There was a strong linear correlation between CAAD and CA-MC (r = 0.784, p < 0.001), C2 tilt (r = 0.745; p < 0.001), and UEV tilt (r = 0.519; p = 0.033). There was no correlation between CAAD and either CA-SC or T1 tilt.
CONCLUSIONS: Children with cervical or cervicothoracic scoliosis tend to have a CAAD toward the convexity of the scoliosis that correlates to CA-MC, C2-tilt, and UEV-tilt. CAAD may be seen as a compensatory mechanism to keep the head in a horizontal position. Severe or progressive CAAD may result in destruction of the atlantoaxial joint, including severe complaints, thus necessitating close follow-up and possibly early surgical treatment. Moreover, CAAD might be a useful additional radiographic parameter to be checked in future scoliosis studies.