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首页> 外文期刊>Neurosurgical focus >Limitations and ceiling effects with circumferential minimally invasive correction techniques for adult scoliosis: Analysis of radiological outcomes over a 7-year experience
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Limitations and ceiling effects with circumferential minimally invasive correction techniques for adult scoliosis: Analysis of radiological outcomes over a 7-year experience

机译：对成人脊柱侧凸周向微创校正技术的限制和天花板效应：7年体验的放射性结果分析

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Object: Minimally invasive correction of adult scoliosis is a surgical method increasing in popularity. Limited data exist, however, as to how effective these methodologies are in achieving coronal plane and sagittal plane correction in addition to improving spinopelvic parameters. This study serves to quantify how much correction is possible with present circumferential minimally invasive surgical (cMIS) methods. Methods: Ninety patients were selected from a database of 187 patients who underwent cMIS scoliosis correction. All patients had a Cobb angle greater than 15? or more levels fused, and availability of preoperative and postoperative 36-inch standing radiographs. The mean duration of follow-up was 37 months. Preoperative and postoperative Cobb angle, sagittal vertical axis (SVA), coronal balance, lumbar lordosis (LL), and pelvic incidence (PI) were measured. Scatter plots were performed comparing the pre- and postoperative radiological parameters to calculate ceiling effects for SVA correction, Cobb angle correction, and PI-LL mismatch correction. Results: The mean preoperative SVA value was 60 mm (range 11.5-151 mm); the mean postoperative value was 31 mm (range 0-84 mm). The maximum SVA correction achieved with cMIS techniques in any of the cases was 89 mm. In terms of coronal Cobb angle, a mean correction of 61% was noted, with a mean preoperative value of 35.8齬ange 15?.7齛nd a mean postoperative value of 13.9齬ange 0?.5?A ceiling effect for Cobb angle correction was noted at 42齌he ability to correct the PI-LL mismatch to 10qas limited to cases in which the preoperative PI-LL mismatch was 38ir less. Conclusions: Circumferential MIS techniques as currently used for the treatment of adult scoliosis have limitations in terms of their ability to achieve SVA correction and lumbar lordosis. When the preoperative SVA is greater than 100 mm and a substantial amount of lumbar lordosis is needed, as determined by spinopelvic parameter calculations, surgeons should consider osteotomies or other techniques that may achieve more lordosis.
机译：目的：在成人脊柱侧凸的微创纠正是一种普及的手术方法。然而，除了改善旋纱参数之外，这些方法在实现冠状平面和矢状平面校正方面的有效性存在有限的数据。本研究有助于量化具有目前周向微创手术（CMIS）方法的可能性的校正。方法：九十名患者选自187名患者的CMIS脊柱侧凸矫正的数据库。所有患者均具有大于15的COBB角度？或更多级别融合，以及术前和术后36英寸站立射线照片的可用性。随访的平均持续时间为37个月。测量术前和术后COBB角度，矢状垂直轴（SVA），冠状平衡，腰椎病症（LL）和盆腔发射（PI）。进行散射图比较预先和术后放射性参数来计算SVA校正，COBB角度校正和PI-LL失配校正的天花板效应。结果：平均术前SVA值为60毫米（范围11.5-151毫米）;平均术后值为31毫米（范围0-84mm）。在任何情况下使用CMIS技术实现的最大SVA校正为89毫米。就冠状谱角度而言，注意到61％的平均校正，平均术前值为35.8‰龉龉15？.7÷Nd一个平均术后值13.9°龉龉龉0≤.5？Cobb角度的天花板效果42‰的能力注意到校正能够将PI-LL不匹配校正为10QAS限于术前PI-LL Mismatch少38尺寸的情况。结论：目前用于治疗成人脊柱病的周向MIS技术在实现SVA校正和腰椎病的能力方面具有局限性。当术前SVA大于100毫米并且需要大量的腰椎病时，如纺丝髓参数计算所确定的，外科医生应考虑截骨或其他可能达到更多猪洞的技术。

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