| Objectives:We retrospectively analyzed the clinical data of previously admitted adult patients with degenerative scoliosis,summarized the characteristics of their clinical manifestations and imaging parameters,and discussed the role of horizontal rotation in the three-dimensional deformity of degenerative scoliosis,with the aim of providing new ideas and understanding for the prevention and treatment of adult degenerative scoliosis in clinical practice.Methods:Retrospective analysis of the data related to 80 adult patients with degenerative scoliosis admitted to our department during the period from April 2017 to December 2022,perfected the imaging examinations related to full-length frontal and lateral X-ray of the spine,bending position films,3D CT and MRI,etc.The imaging parameters obtained by measurement were:direction of scoliosis,distribution of the parietal vertebrae,rotation angle AVR of the parietal vertebrae,coronal The sagittal correlation parameters:thoracolumbar lordosis TLK,lumbar lordosis LL,sagittal balance SVA and pelvic parameters:pelvic incidence angle PI,pelvic tilt angle PT and sacral tilt angle SS were summarized by using pearson correlation analysis to assess the relationship between parietal rotation AVR and coronal The correlations between facet-related parameters CA,AVT,CVA and sagittal pelvic-related parameters TLK,LL,SVA,PI,PT and SS were summarized and the risk factors for AVR of parietal rotation were clarified using multi-factor linear regression analysis.Results:A total of 80 patients were included in this study,including 28 males and 52 females,aged 45-80 years,mean(64.09±10.02)years,BMI 17.50-26.00 kg/m2,mean(21.04±2.09)kg/m2,lateral convexity direction left and right in 40 cases each,parietal segmental distribution:L1:9 cases,L1.2 intervertebral space:7 cases,L2:L1:9 cases,L1.2 intervertebral space:7 cases,L2:19 cases,L2.3 intervertebral space:13 cases,L3:23 cases and L4:9 cases.There was a significant correlation between the AVR of parietal rotation and the coronal Cobb angle CA and the AVT of coronal horizontal displacement(p<0.001).Among them,parietal rotation(AVR)was correlated with coronal Cobb angle(CA)(correlation coefficient r=0.776,p<0.001)and with coronal horizontal displacement(AVT)(r=0.650,p<0.001).In contrast,the correlation between AVR and CVA,sagittal plane related parameters TLK,LL,SVA and pelvic parameters PI,PT and SS was not statistically significant.On the basis of this correlation analysis,a multifactorial linear regression analysis of imaging parameters was performed,and the statistical results showed that there was no significant correlation between CVA,TLK,LL,SVA,PI,PT and SS and AVR(p>0.05).both CA and AVT were significantly correlated with AVR(p<0.05).both CA and AVT were risk factors for increased AVR(p<0.05 The linear regression equation was AVR(°)=-5.603+0.347 × CA(°)+3.912 × AVT(cm),and its goodness of fit R2=0.735.indicating that nearly 73%of the variation in AVR could be explained by CA and AVT.Conclusions:The following possible conclusions can be drawn from this study:1.The AVR of parietal rotation in adult degenerative scoliosis is significantly and positively correlated with the coronal Cobb angle and the AVT of the horizontal coronal displacement,both of which are risk factors for increased AVR.An increase in the coronal Cobb angle or an increase in the horizontal coronal displacement may further aggravate the rotation of the parietal spine.2.There was no significant correlation between parietal rotation and sagittal and pelvic parameters in adults with degenerative scoliosis.Objectives:To evaluate the orthopedic effect and prognostic efficacy of posterior PCO osteotomy combined with intervertebral release fusion for horizontal rotation in adults with stiff degenerative scoliosis,with the aim of providing new ideas and understanding for the corrective treatment of vertebral rotation in adults with stiff degenerative scoliosis.Methods:We retrospectively analyzed the clinical data of 23 adult patients with stiff(<30%flexibility)degenerative scoliosis admitted to our hospital from May 2016 to November 2021 who underwent posterior PCO osteotomy combined with intervertebral release fusion with complete treatment data.Their basic information,general clinical data,surgery,postoperative efficacy and last follow-up were counted.The patients’ VAS scores for low back pain and Oswestry deficit index(ODI)for lumbar spine function were evaluated preoperatively,1 week postoperatively and at the last follow-up visit,respectively,and the imaging parameters such as coronal Cobb angle,thoracolumbar lordosis(TLK),lumbar anterior lordosis(LL),sagittal balance(SVA)and parietal rotation(AVR)were measured by the formula The improvement rates of imaging and prognostic indexes were calculated.The orthopedic effect and prognostic efficacy of posterior PCO osteotomy combined with intervertebral release fusion for the treatment of stiff degenerative scoliosis vertebral rotation in adults were evaluated using relevant statistical methods.Results:1.Basic informationA total of 23 patients were included in this study,including 9 males and 14 females,aged 45-78 years,mean(65.48±9.52)years,with BMI 17.80-25.70 kg/m2,mean(21.07±1.91)kg/m2.Patients had spinal flexibility<10%:3 cases(13%),10%<20%flexibility:7 cases(30%)and 20%<30%flexibility:13 cases(57%).The patients had a high rate of combined underlying diseases,including 4 patients(17%)with coronary heart disease,6 patients(26%)with hypertension,5 patients(21%)with diabetes mellitus,3 patients(13%)with hyperlipidemia,2 patients(8%)with respiratory diseases and 10 patients(43%)with osteoporosis,including 4 patients(17%)with two or more combined underlying diseases.The patients all had more severe symptoms of low back stiffness deformity,low back pain and lower extremity pain and numbness,among which 18 patients(78%)had obvious symptoms of spinal stenosis such as intermittent claudication,and 6 patients(26%)showed sagittal imbalance of the spine and could palpate a more obvious posterior convexity deformity.2.Surgical situationThe average operative time was(175.86 ± 41.61)min,the average intraoperative bleeding was(580.73 ± 134.56)ml,the average postoperative drainage was(322.57 ±153.69)ml,the average postoperative follow-up was(24.39 ± 7.14)months,and the average postoperative bed rest was(3.20 ± 1.23)d.The average fused segment was(9.50 ± 1.86).The average number of fused segments was(9.50± 1.86)and the average number of posterior column osteotomy segments was(4.70± 1.03).One patient had cerebrospinal fluid leakage,one patient had junctional kyphosis,and two patients had delayed postoperative wound healing,which were treated accordingly without serious adverse consequences.3.Treatment effectComparison between preoperative and postoperative 1 week and the last follow-up:the coronal Cobb angle was lower than the preoperative level at 1 week and the last follow-up,and the difference was statistically significant(p<0.05),and the improvement rate was(77.32 ± 21.53)%.The TLK and SVA at 1 week postoperatively and at the last follow-up were lower than the preoperative level,and the LL was higher than the preoperative level,and the difference was statistically significant(p<0.05),and the improvement rate of SVA was(64.27 ± 8.70)%.The AVR of parietal rotation was lower than the preoperative level at 1 week after surgery and at the last follow-up,and the difference was statistically significant(p<0.05),and the improvement rate of AVR was(62.64 ± 10.39)%.The improvement rate of VAS was(73.67±9.92)%and the improvement rate of ODI was(72.35±7.87)%.Conclusions:The following possible conclusions can be drawn from this study:1.posterior PCO osteotomy combined with intervertebral release fusion for the treatment of stiff degenerative scoliosis in adults can obtain not only better coronal and sagittal orthopedic results,but also better correction of horizontal rotational deformity.2.Adequate posterior release,complete decompression of the spinal canal,and good three-dimensional deformity correction are the main ways to obtain satisfactory results in the correction of stiff degenerative scoliosis in adults.3.Posterior PCO osteotomy is an adjunctive approach to the treatment of stiff degenerative scoliosis in adults,aiming at posterior column release of the stiff segments and without the need for high-level osteotomy. |
PDF Full Text Request