Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Republic of Korea.
Spine (Phila Pa 1976). 2010 Aug 1;35(17):1595-601. doi: 10.1097/BRS.0b013e3181bdad89.
A retrospective study of clinical results of operative treatment for degenerative lumbar scoliosis.
To determine the risk factors of sagittal decompensation after long instrumentation and fusion to L5 or S1.
Little is known about the risk factors for sagittal decompensation, which was defined in this study as sagittal C7 plumb falling anterior >8 cm from the posterosuperior corner of the sacrum.
Forty-five patients (mean age: 64.4 year) with adult degenerative lumbar scoliosis were reviewed retrospectively with a minimum 2 years. The mean number of levels fused was 6.1 +/- 1.6 segments. The upper instrumented vertebra ranged from T9 to L2. The lower instrumented vertebra was L5 and S1 in 24 and 21 patients, respectively.
Sagittal decompensation (SD) developed in 19 patients. The most significant risk factors of SD were preoperative sagittal imbalance and high pelvic incidence. The preoperative sagittal C7 plumb was more positive (67.9 mm) in the decompensation group than in the balance group (37.0 mm) (P = 0.002). There was a significant difference in pelvic incidence between 61.7 degrees in the decompensation and 54.9 degrees in the balance group (P = 0.01). The preoperative lumbar lordosis was hypolordotic in the decompensation group, however, it was not found to be a risk factor. Pseudarthrosis was identified at the lumbosacral junction in 5 patients, and 4 of them (80%) had SD. SD developed in 55% of patients who had loosening of the distal screws and 50% of patients with hypolordotic lumbar fusion. Distal adjacent segment disease was more likely to cause SD than proximal adjacent segment disease.
Sagittal decompensation is common after long posterior instrumentation and fusion for degenerative lumbar scoliosis. It is mostly associated with complications at the distal segments, including pseudarthrosis and implant failure at the lumbosacral junction. Restoration of optimal lumbar lordosis and secure lumbosacral fixation is necessary especially in patients with preoperative sagittal imbalance and high pelvic incidence in order to prevent sagittal decompensation after surgery.
退行性腰椎侧凸手术治疗的临床结果回顾性研究。
确定长节段内固定融合至 L5 或 S1 后矢状面失代偿的危险因素。
对于矢状面失代偿的危险因素知之甚少，本研究中定义为矢状面 C7 铅垂线从前上骶骨角向前方>8cm。
回顾性分析 45 例（平均年龄 64.4 岁）成人退行性腰椎侧凸患者，随访时间至少 2 年。融合节段平均为 6.1±1.6 个。上固定椎范围从 T9 到 L2。下固定椎分别为 L5 和 S1 的患者有 24 例和 21 例。
19 例患者出现矢状面失代偿（SD）。SD 的最重要危险因素是术前矢状面失平衡和高骨盆入射角。失代偿组的术前矢状面 C7 铅垂线较平衡组（37.0mm）更正（67.9mm）（P=0.002）。失代偿组骨盆入射角为 61.7°，平衡组为 54.9°，两组差异有统计学意义（P=0.01）。失代偿组术前腰椎前凸呈低前凸，但不是危险因素。5 例患者在腰骶连接处发现假关节，其中 4 例（80%）出现 SD。远端螺钉松动的患者中，有 55%发生 SD，腰椎融合呈低前凸的患者中，有 50%发生 SD。远端相邻节段疾病比近端相邻节段疾病更易导致 SD。
退行性腰椎侧凸后路长节段内固定融合后矢状面失代偿常见。它主要与远端节段的并发症有关，包括腰骶连接处的假关节和植入物失败。为了防止术后矢状面失代偿，特别是对于术前矢状面失平衡和高骨盆入射角的患者，有必要恢复最佳腰椎前凸和腰骶部固定。
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