Modificaciones del plano sagital cervical luego del tratamiento quirúrgico posterior en la escoliosis idiopática del adolescente Lenke 1

• Autores: Sebastian Solsona, Aroldo C. Legarreta, Gabriel E. Rositto, Juan M. Reviriego, Maria N. Escalada
• Localización: Revista de la Asociación Argentina de Ortopedia y Traumatología, ISSN 1852-7434, Vol. 79, Nº. 3, 2014, págs. 169-178
• Idioma: español
• DOI: 10.15417/337
• Títulos paralelos:
  • Changes in the cervical alignment after posterior transpedicular instrumentation in Lenke type 1 adolescent idiopathic scoliosis
• Enlaces
  • Texto completo (pdf)
• Resumen
  • español

    In­tro­duc­ción: Como la cifosis torácica y la lordosis cervical son directamente proporcionales, las modificaciones del plano sagital torácico impactarían sobre la columna cervical. Nuestro objetivo fue detectar cambios en el plano sagital cervical, a corto y mediano plazo, durante el tratamiento quirúrgico según una técnica posterior.Materiales ­y ­Métodos:­ Estudio retrospectivo radiográfico de tipo serie de casos, entre enero de 2005 y abril de 2009. Criterios de inclusión: escoliosis idiopática del adolescente Lenke 1, tratamiento por vía posterior con tornillos transpediculares. Seguimiento mínimo 2 años. Parámetros analizados: nivel Cobb, nivel de instrumentación proximal, densidad de implantes, lordosis cervical, cifosis torácica proximal, cifosis torácica principal, inclinación sagital T1, balance sagital global, balance sagital cervical. Análisis estadístico mediante ANOVA de muestras repetitivas y Tukey, con el programa Graph-Pad-Prism. Resultados: 25 pacientes. Seguimiento promedio 4,3 años. Cifosis torácica: media preoperatoria 26,8º, posoperatoria 20,6º. Efecto lordotizante después del tratamiento quirúrgico (p ≤0,001). La inclinación sagital T1 y la cifosis proximal T2-T5 (p ≤0,038) mostraron un incremento hacia el último control. El 72% presentaba rectificación o cifosis cervical antes de la cirugía. El 44% experimentó una mejoría hacia el último control. Los niveles de artrodesis más altos se correlacionaron con los casos que empeoraron su contorno sagital posoperatorio. Conclusiones:­ Nuestra técnica de corrección generó un efecto lordotizante torácico. Esto se tradujo, a mediano plazo, en un incremento de la retropulsión del tronco y rectificación o pérdida de la lordosis a nivel cervical.  

  • English

    Background: As thoracic kyphosis and cervical lordosis are proportionally related, every change in the thoracic sagittal plane will impact on the cervical alignment. Our objective was to detect changes in the sagittal cervical plane at short and medium term follow-up during surgical treatment, according to the posterior technique.Methods:­ Retrospective, radiographic case series study performed between January 2005 and April 2009. Inclusion criteria: Lenke type 1 adolescent idiopathic scoliosis, and posterior screw fixation surgery.Radiographic parameters: Cobb angle, uppermost instrumented vertebra, implant density, cervical lordosis, proximal thoracic kyphosis, main thoracic kyphosis, T1 sagittal tilt, global sagittal balance and cervical sagittal balance. Statistical analysis: ANOVA of repetitive samples and Tukey, using the Graph-Pad-Prism.Results: 25 patients. Mean follow-up 4.3 years. Thoracic kyphosis (T5-T12): average, preoperative 26.8º and 20.6º postoperative. Lordosing effect after surgical treatment (p ≤0.001). T1 sagittal tilt and T2-T5 proximal thoracic kyphosis (p ≤0.038) tended to increase at last control. Seventy two per cent of our sample showed rectification or even cervical kyphosis before surgery. Only 44% had certain better alignment at the last follow-up. Higher UIV correlated with a worse cervical plane alignment after surgery.Conclusions:­ Our derotational concavity technique with poliaxial pedicle screws and titanium 5.5 rod demonstrated a lordosing effect in the thoracic sagittal plane. This was translated into a trunk retropulsion and rectification or lost of lordosis in the sagittal cervical plane in the medium-term follow-up. 

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