腰椎前凸恢复对腰椎退行性后凸患者胸椎曲度及矢状位的影响。

Influence of lumbar lordosis restoration on thoracic curve and sagittal position in lumbar degenerative kyphosis patients.

作者信息

Jang Jee-Soo, Lee Sang-Ho, Min Jun-Hong, Maeng Dae Hyeon

机构信息

Department of Neurosurgery, Seoul Wooridul Hospital, Seoul, Korea.

出版信息

Spine (Phila Pa 1976). 2009 Feb 1;34(3):280-4. doi: 10.1097/BRS.0b013e318191e792.

DOI:10.1097/BRS.0b013e318191e792

PMID:19179923

Abstract

STUDY DESIGN

A retrospective study.

OBJECTIVES

To determine postsurgical correlations between thoracic and lumbar sagittal curves in lumbar degenerative kyphosis (LDK) and to determine predictability of spontaneous correction of thoracic curve and sacral angle after surgical restoration of lumbar lordosis and fusion.

SUMMARY OF BACKGROUND DATA

To our knowledge, there are only a limited number of articles about the relationship between thoracic and lumbar curve in sagittal thoracic compensated LDK.

METHODS

Retrospective review of 53 consecutive patients treated with combined anterior and posterior spinal arthrodesis. We included patients with sagittal thoracic compensated LDK caused by sagittal imbalance in this study. Total lumbar lordosis, thoracic kyphosis, sacral slope, and C7 plumb line were measured on the pre- and postoperative whole spine lateral views. Postoperative changes in thoracic kyphosis, sacral slope, and C7 plumb line according to the surgical lumbar lordosis restoration were measured and evaluated.

RESULTS

The mean preoperative sagittal imbalance by plumb line was 78.3 mm (+/-76.5); this improved to 13.6 mm (+/-25) after surgery (P < 0.0001). Mean lumbar lordosis was 9.4 degrees (+/-19.2) before surgery and increased to 38.4 degrees (+/-13.1) at follow-up (P < 0.0001). Mean thoracic kyphosis was 1.1 degrees (+/-12.7) before surgery and increased to 17.6 degrees (+/-12.2) at follow-up (P < 0.0001). Significant preoperative correlations existed between kyphosis and lordosis (r = 0.772, P < 0.0001) and between lordosis and sacral slope (r = 0.785, P < 0.0001). Postoperative lumbar lordosis is correlated to thoracic kyphosis increase (r = 0.620, P < 0.0001). Postoperative lumbar lordosis is correlated to sacral slope increase (r = 0.722, P < 0.0001).

CONCLUSION

Reciprocal relationship exists between lumbar lordosis and thoracic kyphosis in sagittal thoracic compensated LDK. Surgical restoration of lumbar lordosis for LDK brings about high level of statistical correlation to thoracic kyphosis improvement. At the same time, the reciprocal relationship is maintained.

摘要

研究设计

一项回顾性研究。

目的

确定腰椎退行性后凸畸形（LDK）中胸段和腰段矢状面曲线的术后相关性，并确定在手术恢复腰椎前凸和融合后胸段曲线和骶骨角自发矫正的可预测性。

背景数据总结

据我们所知，关于矢状面胸段代偿性LDK中胸段和腰段曲线之间关系的文章数量有限。

方法

对53例连续接受前后路脊柱融合术治疗的患者进行回顾性分析。本研究纳入因矢状面失衡导致矢状面胸段代偿性LDK的患者。在术前和术后的全脊柱侧位片上测量腰椎前凸、胸段后凸、骶骨倾斜度和C7铅垂线。根据手术恢复的腰椎前凸情况，测量并评估胸段后凸、骶骨倾斜度和C7铅垂线的术后变化。

结果

术前铅垂线测量的矢状面平均失衡为78.3 mm（±76.5）；术后改善至13.6 mm（±25）（P < 0.0001）。术前平均腰椎前凸为9.4度（±19.2），随访时增加至38.4度（±13.1）（P < 0.0001）。术前平均胸段后凸为1.1度（±12.7），随访时增加至17.6度（±12.2）（P < 0.0001）。术前后凸与前凸之间存在显著相关性（r = 0.772，P < 0.0001），前凸与骶骨倾斜度之间也存在显著相关性（r = 0.785，P < 0.0001）。术后腰椎前凸与胸段后凸增加相关（r = 0.620，P < 0.0001）。术后腰椎前凸与骶骨倾斜度增加相关（r = 0.722，P < 0.0001）。