فیوژن انتخابی توراکولومبار/لومبار در اسکولیوز ایدیوپاتیک نوجوانان(مقاله مروری)

نوع مقاله : مروری

نویسندگان

مرکز تحقیقات تروما، دانشگاه علوم پزشکی بقیه‌الله (عج)، تهران، ایران

چکیده
اسکولیوز ایدیوپاتیک نوجوانان (AIS) یک ناهنجاری سه‌بعدی ستون فقرات و عامل ناتوانی‌های جسمی-روانی است. درمان پیش ‌از جراحی برای بهبود ظاهر بیمار و حفظ عملکرد ستون فقرات حیاتی است. جراحی اصلاحی، تحرک و تعادل ستون فقرات را بازمی‌گرداند. در موارد دو انحنای هم‌زمان، فیوژن انتخابی با اصلاح یک انحنا، موجب اصلاح خودبه‌خودی انحنای دوم می‌شود. این روش به دلیل حفظ حرکت بیشتر ستون فقرات موردتوجه جراحان است، ولی کمبود اطلاعات، مانع استفاده گسترده از آن شده است. مطالعه حاضر فیوژن انتخابی توراکولومبار/لومبار را بررسی کرده و نتایج جراحی و عوارض آن را برای جراحان تشریح می‌کند تا انتخاب روش جراحی تسهیل شود. شواهد تأیید می‌کنند که فیوژن انتخابی توراسیک برای AIS مؤثر و ایمن است و اصلاح قابل توجهی را ارائه می‌دهد، کیفیت زندگی را بهبود می‌بخشد و عوارض کمتری در مقایسه با رویکردهای گسترده دارد. تحقیقات آینده معیارهای انتخاب بیمار را بهبود بخشیده و اثرات بلندمدت را بررسی کنند.

کلیدواژه‌ها

موضوعات

عنوان مقاله English

Adolescent Idiopathic Scoliosis: Selective Thoracolumbar/Lumbar Fusion(Review Article)

نویسندگان English

Mohsen Motalebi
Alireza Shakerisefat
Hamid Hesarikia
Keivan Asadi
Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
چکیده English

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity causing physical/psychological burdens. Optimal preoperative planning enhances appearance while preserving spinal function. Corrective surgery restores spinal mobility and balance. In dual-curve cases, selective fusion corrects one curve, inducing spontaneous correction of the other—preserving spinal motion and attracting surgical interest. However, limited adoption persists due to insufficient data. This study evaluates selective thoracolumbar/lumbar fusion, detailing surgical outcomes and complications to guide surgeons in procedure selection. Evidence confirms selective thoracic fusion is effective and safe for AIS, offering significant correction, improved quality of life, and fewer complications versus extensive approaches. Future research should refine patient criteria and assess long-term effects.

کلیدواژه‌ها English

Scoliosis
Kyphosis
Spine
1         Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, et al. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am. 2001;83(8):1169-1181. doi:10.2106/00004623-200108000-00006
2         King HA, Moe JH, Bradford DS, Winter RB. The selection of fusion levels in thoracic idiopathic scoliosis. J Bone Joint Surg Am. 1983;65(9):1302-1313. doi:10.2106/00004623-198365090-00005
3         Moe JH. Modern concepts of treatment of spinal deformities in children and adults. Clin Orthop Relat Res. 1980;(150):137-153. PMID: 7438602
4         Edwards CC, Lenke LG, Peelle M, Sides B, Rinella A, Bridwell KH. Selective thoracic fusion for adolescent idiopathic scoliosis with C modifier lumbar curves: 2- to 16-year radiographic and clinical results. Spine. 2004;29(5):536-546. doi:10.1097/01.brs.0000108743.10876.8b
5         Senkoylu A, Luk KD, Wong YW, Cheung KM. Prognosis of spontaneous thoracic curve correction after the selective anterior fusion of thoracolumbar/lumbar (Lenke 5C) curves in idiopathic scoliosis. Spine J. 2014;14(7):1117-1124. doi:10.1016/j.spinee.2013.07.464
6         Studer D, Awais A, Williams N, Antoniou G, Eardley-Harris N, Cundy P. Selective fusion in adolescent idiopathic scoliosis: a radiographic evaluation of risk factors for imbalance. J Child Orthop. 2015;9(2):153-160. doi:10.1007/s11832-015-0654-z
7         Bosch P, Kenkre TS, Londino JA, Cassara A, Yang C, Waters JH. Coagulation profile of patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion. J Bone Joint Surg Am. 2016;98(20):e88. doi:10.2106/JBJS.15.01384
8         Jiang J, Qian BP, Qiu Y, Wang B, Yu Y, Zhu ZZ. Full fusion of proximal thoracic curve helps to prevent postoperative cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients with right-elevated shoulder. BMC Musculoskelet Disord. 2017;18(1):1-7. doi:10.1186/s12891-017-1797-5
9         Lenke LG, Edwards CC, Bridwell KH. The Lenke classification of adolescent idiopathic scoliosis: how it organizes curve patterns as a template to perform selective fusions of the spine. Spine. 2003;28(20):S199-207. doi:10.1097/01.BRS.0000092219.13639.96
10      Lee CS, Hwang CJ, Lee DH, Cho JH. Five major controversial issues about fusion level selection in corrective surgery for adolescent idiopathic scoliosis: a narrative review. Spine J. 2017;17(7):1033-1044. doi:10.1016/j.spinee.2017.03.019
11      Dwyer A, Schafer MF. Anterior approach to scoliosis: results of treatment in fifty-one cases. J Bone Joint Surg Br. 1974;56(2):218-224. doi:10.1302/0301-620X.56B2.218
12      Ogilvie JW. Anterior spine fusion with Zielke instrumentation for idiopathic scoliosis in adolescents. Orthop Clin North Am. 1988;19(2):313-317. PMID: 3282199
13      Deviren V, Berven S, Kleinstueck F, Antinnes J, Smith JA, Hu SS. Predictors of flexibility and pain patterns in thoracolumbar and lumbar idiopathic scoliosis. Spine. 2002;27(21):2346-2349. doi:10.1097/00007632-200211010-00008
14      Huitema GC, Jansen RC, van Ooij A, Punt IM, van Rhijn LW. Predictability of spontaneous thoracic curve correction after anterior thoracolumbar correction and fusion in adolescent idiopathic scoliosis. Spine J. 2015;15(5):966-970. doi:10.1016/j.spinee.2013.06.091
15      Majd ME, Castro FP, Holt RT. Anterior fusion for idiopathic scoliosis. Spine. 2000;25(6):696-702. doi:10.1097/00007632-200003150-00008
16      Lenke LG, Bridwell KH, Baldus C, Blanke K. Preventing decompensation in King type II curves treated with Cotrel-Dubousset instrumentation. Spine. 1992;17(8 Suppl):S274-281. doi:10.1097/00007632-199208001-00004
17      Sanders AE, Baumann R, Brown H, Johnston CE, Lenke LG, Sink E. Selective anterior fusion of thoracolumbar/lumbar curves in adolescents: when can the associated thoracic curve be left unfused? Spine. 2003;28(7):706-713. doi:10.1097/01.BRS.0000051923.07449.9A
18      Dwyer A, Newton N, Sherwood A. An anterior approach to scoliosis. Clin Orthop Relat Res. 1969;62:192-202. PMID: 5785953
19      Luk KD, Leong JC, Reyes L, Hsu LC. The comparative results of treatment in idiopathic thoracolumbar and lumbar scoliosis using the Harrington, Dwyer, and Zielke instrumentations. Spine. 1989;14(3):275-280. doi:10.1097/00007632-198903000-00007
 
20      Lenke L, Clements D, Harms J, Newton P, et al. Anterior single-rod instrumentation of the thoracic and lumbar spine: saving levels. Spine. 2003;28(20):S208-216. doi:10.1097/01.BRS.0000092218.87251.07
21      Wang ZW, Shen YQ, Wu Y, Li J, Liu Z, Xu JK, et al. Anterior Selective Lumbar Fusion Saving More Distal Fusion Segments Compared with Posterior Approach in the Treatment of Adolescent Idiopathic Scoliosis with Lenke Type 5. Orthop Surg. 2021;13(8):2327-2334. doi:10.1111/os.13074
22      Hee HT, Yu ZR, Wong HK. Comparison of segmental pedicle screw instrumentation versus anterior instrumentation in adolescent idiopathic thoracolumbar and lumbar scoliosis. Spine. 2007;32(14):1533-1542. doi:10.1097/BRS.0b013e318067dc24
23      Geck MJ, Rinella A, Hawthorne D, Macagno A, Koester L, Sides B, et al. Comparison of surgical treatment in Lenke 5C adolescent idiopathic scoliosis: anterior dual rod versus posterior pedicle fixation surgery. Spine. 2009;34(18):1942-1951. doi:10.1097/BRS.0b013e3181b03d82
24      Li M, Ni J, Fang X, Liu H, Zhu X, He S, et al. Comparison of selective anterior versus posterior screw instrumentation in Lenke5C adolescent idiopathic scoliosis. Spine. 2009;34(11):1162-1166. doi:10.1097/BRS.0b013e31819e2c44
25      Tanaka M, Fujiwara Y, Uotani K, Yamauchi T, Misawa H. C-Arm-Free Anterior Correction for Adolescent Idiopathic Scoliosis (Lenke Type 5C): Analysis of Early Outcomes and Complications. World Neurosurg. 2021;149:e1090-e1097. doi:10.1016/j.wneu.2021.03.133
26      Sweet FA, Lenke LG, Bridwell KH, Blanke KM, Whorton J. Prospective radiographic and clinical outcomes and complications of single solid rod instrumented anterior spinal fusion in adolescent idiopathic scoliosis. Spine. 2001;26(18):1956-1965. doi:10.1097/00007632-200109150-00007
27      Shufflebarger HL, Geck MJ, Clark CE. The posterior approach for lumbar and thoracolumbar adolescent idiopathic scoliosis: posterior shortening and pedicle screws. Spine. 2004;29(3):269-276. doi:10.1097/01.BRS.0000109882.74125.19
28      Yoshihara H. Surgical Treatment of Lenke Type 5 Adolescent Idiopathic Scoliosis: A Systematic Review. Spine. 2019;44(13):E788-E799. doi:10.1097/BRS.0000000000003019
29      Bin Y, Zhang JG, Qiu GX, Lu WC, Wang YP, Shen JX, et al. Selective anterior thoracolumbar/lumbar fusion and instrumentation in adolescent idiopathic scoliosis patients. Chin Med J. 2010;123(21):3003-3008. doi:10.3760/cma.j.issn.0366-6999.2010.21.011
30      Zhang Y, Lin G, Zhang J, Guo J, Wang S, Yang Y, et al. Radiographic evaluation of posterior selective thoracolumbar or lumbar fusion for moderate Lenke 5C curves. Arch Orthop Trauma Surg. 2017;137(1):1-8. doi:10.1007/s00402-016-2594-6
31      Yang C, Zhao Y, Zhai X, Li J, Zhu X, Li M. Coronal balance in idiopathic scoliosis: a radiological study after posterior fusion of thoracolumbar/lumbar curves (Lenke 5 or 6). Eur Spine J. 2017;26(6):1775-1781. doi:10.1007/s00586-016-4921-6
32      Matsumura A, Iwamae M, Namikawa T, Kato M, Hori Y, Hidaka N, et al. Spontaneous improvement of postoperative coronal imbalance following selective thoracolumbar-lumbar fusion in Lenke 5C adolescent idiopathic scoliosis. World Neurosurg. 2021;148:e269-e275. doi:10.1016/j.wneu.2021.01.147
33      Li J, Hwang SW, Shi Z, Yan N, Yang C, Wang C, et al. Analysis of radiographic parameters relevant to the lowest instrumented vertebrae and postoperative coronal balance in Lenke 5C patients. Spine. 2011;36(20):1673-1678. doi:10.1097/BRS.0b013e31820e626e
34      Hwang CJ, Lee CS, Kim H, Lee DH, Cho JH. Spontaneous correction of coronal imbalance after selective thoracolumbar-lumbar fusion in patients with Lenke-5C adolescent idiopathic scoliosis. Spine J. 2018;18(10):1822-1828. doi:10.1016/j.spinee.2018.03.013
35      Yang X, Liu L, Song Y, Zhou C, Zhou Z, Wang L, et al. Pre- and postoperative spinopelvic sagittal balance in adolescent patients with Lenke type 5 idiopathic scoliosis. Spine. 2015;40(2):102-108. doi:10.1097/BRS.0000000000000688
36      Wang F, Zhou XY, Xu XM, Yang YL, Zhu XD, Bai YS, et al. Cervical sagittal alignment limited adjustment after selective posterior thoracolumbar/lumbar curve correction in patients with Lenke type 5C adolescent idiopathic scoliosis. Spine. 2017;42(9):E539-E546. doi:10.1097/BRS.0000000000001890
37      Etemadifar MR, Andalib A, Yazdi MM, Farzinnia S. Evaluation of long term outcome of selective fusion in patients with idiopathic scoliosis. Int J Burns Trauma. 2021;11(1):48-55. PMID: 33824782
38      Louer C, Yaszay B, Cross M, Bartley CE, Bastrom TP, Shah SA, et al. Ten-year outcomes of selective fusions for adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2019;101(9):761-770. doi:10.2106/JBJS.18.00498
39      Delfino R, Pizones J, Ruiz-Juretschke C, Sánchez-Mariscal F, Zúñiga L, Izquierdo E. Selective Anterior Thoracolumbar Fusion in Adolescent Idiopathic Scoliosis: Long-Term Results After 17-Year Follow-Up. Spine. 2017;42(13):E788-E794. doi:10.1097/BRS.0000000000002001
40      Chen K, Chen Y, Shao J, Zhoutian J, Wang F, Chen Z, et al. Long-Term Follow-up of Posterior Selective Thoracolumbar/Lumbar Fusion in Patients With Lenke 5C Adolescent Idiopathic Scoliosis. Global Spine J. 2020;11(7):1070-1079. doi:10.1177/2192568220965566
41      Shetty AP, Suresh S, Aiyer SN, Kanna R, Rajasekaran S. Radiological factors affecting post-operative global coronal balance in Lenke 5 C scoliosis. J Spine Surg. 2017;3(4):541-547. doi:10.21037/jss.2017.10.01
42      Fortin C, Grunstein E, Labelle H, Parent S, Feldman DE. Trunk imbalance in adolescent idiopathic scoliosis. Spine J. 2016;16(6):687-693. doi:10.1016/j.spinee.2016.01.015
43      Hu B, Yang X, Yang H, Liu L, Chen P, Wang L, et al. Coronal imbalance in Lenke 5C adolescent idiopathic scoliosis regarding selecting the lowest instrumented vertebra. World Neurosurg. 2018;117:e522-e529. doi:10.1016/j.wneu.2018.06.067
44      Lin Y, Chen W, Chen A, Li F, Xiong W. Anterior versus posterior selective fusion in treating adolescent idiopathic scoliosis. World Neurosurg. 2018;111:e830-e844. doi:10.1016/j.wneu.2018.01.002
45      Pan W, Liu Z, Zhao Z, Li J, Zeng C, Zhu Z, et al. Comparison of spontaneous correction in thoracic curves after anterior versus posterior selective fusion in Lenke type 5C adolescent idiopathic scoliosis. Zhonghua Yi Xue Za Zhi. 2018;98(33):2650-5265. doi:10.3760/cma.j.issn.0376-2491.2018.33.010
46      Li J, Zhao Z, Tseng C, Zhu Z, Qiu Y, Liu Z. Selective fusion in Lenke 5 adolescent idiopathic scoliosis. World Neurosurg. 2018;118:e784-e791. doi:10.1016/j.wneu.2018.07.052
47      Chang SY, Son J, Zheng GB, Chang BS, Lee CK, Kim H. Clinical outcomes of selective fusion for the thoracolumbar-lumbar curve in patients with Lenke type 6C adolescent idiopathic scoliosis. J Pediatr Orthop B. 2021;30(3):211-217. doi:10.1097/BPB.0000000000000751
48      Direito-Santos B, Queirós CM, Serrano P, Encarnação Â, Campos A, Oliveira A. Long-term follow-up of anterior spinal fusion for thoracolumbar/lumbar curves in adolescent idiopathic scoliosis. Spine. 2019;44(16):1137-1143. doi:10.1097/BRS.0000000000003041
49      Bunnell WP. The natural history of idiopathic scoliosis before skeletal maturity. Spine. 1986;11(8):773-776. doi:10.1097/00007632-198610000-00003
50      Wang Y, Bünger CE, Zhang Y, Wu C, Li H, Dahl B, et al. Lowest instrumented vertebra selection for Lenke 5C scoliosis: a minimum 2-year radiographical follow-up. Spine. 2013;38(14):E894-900. doi:10.1097/BRS.0b013e31829176c0
51      Zhuang Q, Zhang J, Wang S, Yang Y, Lin G. How to select the lowest instrumented vertebra in Lenke type 5 adolescent idiopathic scoliosis patients? Spine J. 2021;21(1):141-149. doi:10.1016/j.spinee.2020.08.002
52      Ilharreborde B, Ferrero E, Angelliaume A, Lefèvre Y, Accadbled F, Simon AL, et al. Selective versus hyperselective posterior fusions in Lenke 5 adolescent idiopathic scoliosis. Eur Spine J. 2017;26(6):1739-1747. doi:10.1007/s00586-016-4813-9
53      Tauchi R, Kawakami N, Ohara T, Saito T, Tanabe H, Morishita K, et al. Sagittal alignment profile following selective thoracolumbar/lumbar fusion in patients with Lenke type 5C adolescent idiopathic scoliosis. Spine. 2019;44(17):1193-1200. doi:10.1097/BRS.0000000000003043
54      Okubo T, Konomi T, Yanai Y, Furukawa M, Fujiyoshi K, Yamane J, et al. Selective Anterior Fusion Surgery Does Not Influence Global Spinal Sagittal Alignment in Lenke Type 5 Adolescent Idiopathic Scoliosis Patients. Spine. 2022;47(3):234-241. doi:10.1097/BRS.0000000000004254
55      Karademir G, Sarıyılmaz K, Özkunt O, Demirel M, Dikici F, Domaniç Ü. Does Thoracic Kyphosis Have Any Importance in Selective Versus Nonselective Fusion Preference in Patients With Lenke Type 5C Adolescent Idiopathic Scoliosis? J Orthop Res Ther. 2021;2021. doi:10.29011/2575-8241.000545
56      Wang F, Xu XM, Wei XZ, Zhu XD, Li M. Spontaneous thoracic curve correction after selective posterior fusion of thoracolumbar/lumbar curves in Lenke 5C adolescent idiopathic scoliosis. Medicine. 2015;94(29):e1156. doi:10.1097/MD.0000000000001156
57      Xu XM, Wang F, Zhou XY, Liu ZX, Wei XZ, Bai YS, et al. Sagittal balance in adolescent idiopathic scoliosis: a radiographic study of spinopelvic compensation after selective posterior fusion of thoracolumbar/lumbar (Lenke 5C) curves. Medicine. 2015;94(45):e1995. doi:10.1097/MD.0000000000001995