Analisis Korelasi Evaluasi Kesejajaran Sagital dan Koronal terhadap Luaran Fungsional Pasien Skoliosis Idiopatik Pasca Koreksi Deformitas dengan Pendekatan Posterior Release-Only

Bima Baikuni, dr. Yudha Mathan Sakti, Sp.OT(K); dr. Tedjo Rukmoyo, Sp.OT(K)

2024 | Tesis-Spesialis | S2 Orthopaedik dan Traumatologi

Latar Belakang : Skoliosis idiopatik adalah kelainan tiga dimensi yang melibatkan ketidakseimbangan coronal  dan sagittal. Terapi standar untuk koreksi deformitas pada skoliosis idiopatik selama ini menggunakan posterior release only.

Tujuan : Mengevaluasi luaran klinis dan fungsional setelah dilakukan posterior release only deformity correction pada pasien skoliosis idiopatik.

Metode : Studi ini merupakan studi bedah lintang yang melibatkan 29 pasien terdiagnosis skoliosis idiopatik dan menjalani posterior-release only deformity correction. Pemeriksaan radiografi full-length free-standing yang memperlihatkan tulang belakang dan pelvis tersedia untuk semua pasien. Instrumen HRQOL yang digunakan adalah Scoliosis Research Society-22 revised dalam versi Bahasa Indonesia. Paired t-test atau Wilcoxon signed rank test dilakukan antara kesejajaran coronal (Sudut Cobb; CB, Coronal Balance) dan sagittal (SVA, Sagittal Vertebral Axis; PT, Pelvic Tilt; PI-LL, Pelvic Incidence-Lumbar Lordosis; TK, Thoracic Kyphosis; SS, Sacral Slope). Hubungan korelasi antara parameter kesejajaran dengan beberapa variabel perancu (usia saat operasi, Risser’s sign, kurva dan derajat fleksibilitas, jumlah segmen kurva utama) dan HRQoL post-operatif dianalisis.

Hasil : Studi mendapatkan adanya perubahan signifikan pada kesejajaran coronal dan sagittal pada pre-operatif dengan post-operatif, kecuali PI-LL. Hubungan korelasi negatif yang signifikan juga ditemukan antara hamper semua nilai total dan subdomain SRS-22r terhadap parameter kesejajaran, kecuali LL dan SS.

Kesimpulan : Studi ini menunjukkan posterior-release only sebagai metode yang efektif untuk koreksi deformitas pada bidang coronal dan sagittal. Parameter kesejajaran pada bidang coronal dan sagittal memiliki korelasi negatif pada kualtias hidup yang dinilai dengan SRS-22r.

Background : Idiopathic scoliosis is a three-dimensional deformity consisting of coronal and sagittal imbalance. Standard of treatment for deformity correction in idiopathic scoliosis has been posterior release only.

Objective : To evaluate both clinical and functional outcome after posterior release only deformity correction in patients with idiopathic scoliosis.

Method : This is a cross-sectional study involving 29 patients diagnosed with idiopathic scoliosis and underwent posterior-release only deformity correction. Full-length free-standing radiographs including the spine and pelvis were available for all patients. HRQOL instruments include Scoliosis Research Society-22 revised in Indonesian version. Paired t-test or Wilcoxon signed rank test between pre-operative and post-operative coronal alignment (Cobb’s angle; CB, Coronal Balance) and sagittal alignment (SVA, Sagittal Vertebral Axis; PT, Pelvic Tilt; PI-LL, Pelvic Incidence-Lumbar Lordosis; TK, Thoracic Kyphosis; SS, Sacral Slope) were pursued. Correlation of alignment parameters with several confounding variables (age during surgery, Risser’s sign, curve and degree of flexibility, number of segments in the main curve) and post-operative HRQOL were analyzed.

Results : Study shows significant difference was found between pre-operative and post-operative coronal alignment and sagittal alignment, except PI-LL value. Significant negative correlations of SRS-22 values and its domain were found on all alignment parameter, except for LL and SS.

Conclusion : This study shows posterior-release only as an effective method of deformity correction in coronal and sagittal plane. Both coronal and sagittal alignment correlate negatively to quality of life as measured by SRS-22r.

Kata Kunci : Kesejajaran coronal, kesejajaran sagital, kualitas hidup, skoliosis idiopatik