| Objective: One of the purpose of this study is to discover the relationship between coronal deformity and cervical sagittal alignment,by analyzing the imaging data of AIS patients.The other is to investigate the relationship between loss of postoperative coronal correction and spinal sagittal balance reconstruction,and the influence of clinical treatment on the spinal sagittal alignment of patients with AIS,through the images of patients with AIS who underwent surgery and bracing therapy.Methods:1.This is a retrospective study.We collected 454 patients with AIS who went to the Third Hospital of Hebei Medical University for treatment during October 2018 to September 2020 and took anteroposterior and lateral X-ray films of the whole spine in the radiology department.From X-ray films we measured coronal Cobb Angle,cervical lordosis Angle(CL),C1-C2 Angle,T1 slope(T1S),thoracic kyphosis(TK),lumbar lordosis(LL),sacral slope(SS),pelvi ctilt(PT),pelvic incidence(PI)and cerical sagittal vertical axis(c SVA),sagittal vertical axis(SVA).AIS patients were divided into two groups according to the Cobb Angle: cobb Angle ≤45° was group A,and Cobb Angle >45° was group B.Spearman correlation analysis was performed for Cobb Angle and sagittal parameters,CL and other sagittal parameters in two groups.2.This is a retrospective study.We gathered in 22 patients who received surgical treatment and 19 patients who received bracing treatment in the Third Hospital of Hebei Medical University from October 2018 to September 2020.From the whole spine anterio-posterior and lateral X-ray films of the before,after treatment and the last follow-up,we measured Cobb Angle,cervical lordosis(CL),T1 slope(T1S),thoracic kyphosis(TK),lumbar lordosis(LL),sacral slope(SS),pelvic tilt(PT),pelvic incidence(PI)and cerical sagittal vertical axis(c SVA),sagittal vertical axis(SVA).Patients of the surgery group were divided into two groups according to the occurrence of long-term loss of orthopedic effect,the orthopedic loss group and the non-orthopedic loss group.Indepen dent inter-group samplet-test was performed between the 2 groups.Intra-group paired samplet-test was performed for the indicators of the surgery group and bracing group.Results:1.Correlation analysis between cobb Angle and sagittal parameters in AIS showed that: in group A,Cobb Angle and CL is moderate negative correlation(r=-0.637,P<0.001),no obvious linear correlation with the rest of the parameters,correlation of Cobb angle and the C1-C2 Angle,T1 slope and TK are weak(|r|<0.3);in group B,cobb Angle was not significantly correlated with most sagittal parameters,only slightly positively correlated with PT and PI.2.Cervical lordosis(CL)and other sagittal parameters’ correlation analysis showed that: In the group A,CL and T1 slope,thoracic kyphosis(TK),sagittal vertical axis(SVA)were positively correlated relationship(r=0.586,0.490,0.135,P<0.01),CL is negatively related to cerical sagittal axis(c SVA),C1-C2 Angle(r=-0.128,-0.155,P<0.01),no significant correlation with other parameters;In group B,CL was positively correlated with T1 slope,TK,lumbar lordosis(LL),sacral slope(SS),and sagittal vertical axis(SVA)(r=0.661,0.608,0.425,0.434,0.335,P<0.05),but had no significant correlation with other parameters.3.There was no significant difference in preoperative between the orthopedic loss group and the non-orthopedic loss group.After operative,T1 slope(T1S) and thoracic kyphosis(TK)in the orthopedic loss group were lower than those in the non-orthopedic loss group(P=0.018,0.034).At the last follow-up,the cervical lordosis(CL),T1 slope(T1S)and thoracic kyphosis(TK)in the orthopedic loss group were lower than those in the group without orthopedic loss,and the differences were statistically significant(all P<0.05).4.The intra-group comparison results of surgery group showed that there was no statistical significance in the changes of other parameters,except the decrease of Cobb Angle(P<0.001).Between post-and pre-operation,cervical lordosis(CL)continued to increase after surgery(pre-operation 2.47±14.42°vs.post-operation 5.15°±15.34° vs.the last follow-up 8.32°±13.67°),but only the difference between the last follow-up and the preoperative was statistically significant.In the last follow-up and post-operative comparison,cobb Angle increased(P<0.001),T1 slope(T1S)and thoracic kyphosis Angle(TK)decreased slightly(P<0.01),and the differences were statistically significant.In the last follow-up and pre-operation comparison,Cobb Angle decreased(P<0.001),T1 slope(T1S)and thoracic kyphosis(TK)increased(P<0.05),and the differences were statistically significant.5.In the bracing group,the intra-group comparison shows that: after treatment the Cobb Angle,cervical lordosis(CL)reduced(P<0.01),and cervical sagittal vertical axis(cSVA)increase(P=0.008),the remaining parameters changes were no statistical difference before and after treatment,T1S,TK reduced respectively from an average of 25.87°±11.66° before treatment and 43.06°±15.41°to 23.38°±10.05°and 39.31°±13.93°,but there was no statistically significant difference.Conclusions:1.Correlation analysis of AIS patients’ Cobb Angle and spinal sagittal parameters showed that,in the Cobb Angle≤45° group the cervical lordosis(CL)decreased with Cobb Angle decreasing,while in Cobb Angle>45° group there was no significant correlation between CL and Cobb Angle.2.Among the surgical patients,compared with the non-orthopedic loss group,the post-operative cervical and thoracic vertebral curves of the orthopedic loss group were smaller,and more deviated from the range of normal adolescent,suggesting that patients with long-term post-operative orthopedic loss had poor post-operative sagittal balance.3.Compare with pre-operation,the coronal deformity of the surgery group was improved,but part of which was lost during the following-up.The parameters of cervical vertebra and thoracic vertebra in the sagittal plane were improved in the surgry group.While the coronal deformity of the brace group improved after treatment,but at the expense of sagittal curvature loss,with reduced cervical curvature and extension,and reduced thoracic curvature. |
PDF Full Text Request