Spine Unit 2, CHU Pellegrin, Orthopaedic Department, University of Bordeaux, 33076, Bordeaux, France.
Eur Spine J. 2011 Sep;20 Suppl 5(Suppl 5):647-62. doi: 10.1007/s00586-011-1933-0. Epub 2011 Aug 16.
Chronic lower back pain is a potentially incapacitating condition associated with disc degeneration. Although therapy is primarily pharmaceutical, surgery comprising arthrodesis constitutes an alternative. Anterior intersomatic lumbar arthrodesis (ALIF, anterior interbody lumbar fusion) is the reference approach, although total disc arthroplasty may also be undertaken. Analysis of pelvic and spinal parameters provides the best indication of sagittal balance.
This was a prospective study in a continuous series of 99 patients presenting chronic lower back pain due to disc disease. Pelvic incidence, sacral slope, pelvic tilt, spino-sacral angle (SSA) and the four back types in the Roussouly classification were studied in radiographs of the whole spine under load using an EOS imaging system.
The pre-operative SSA value for the study population was 126.09° ± 8.45° and the mean spine tilt angle was 90° compared with 95° in healthy subjects. Following surgery, the SSA was considerably increased in the discal arthroplasty, resulting in a significantly more balanced spinal position. In the group of patients undergoing arthrodesis using the ALIF technique, no such significant improvement was found despite the use of a lordosis cage. We showed that in cases of low pelvic incidence, it was necessary to maintain a Roussouly type 1 or 2 back without increasing lordosis. The results demonstrated the value of L4-L5 disc prostheses in these subjects. L5-S1 arthrodesis seemed a more suitable approach for treating patients with elevated sacral slope (back type 3 or 4). This new type of analysis of sagittal parameters should be performed prior to all surgical procedures involving lumbar prostheses.
慢性下腰痛是一种潜在的使人丧失能力的疾病，与椎间盘退变有关。虽然治疗主要是药物治疗，但包括关节融合术在内的手术也是一种选择。前路腰椎间融合术（ALIF，前路腰椎体间融合术）是参考方法，尽管也可以进行全椎间盘置换术。分析骨盆和脊柱参数可以最好地指示矢状平衡。
这是一项对 99 例因椎间盘疾病引起慢性下腰痛的连续患者进行的前瞻性研究。在负载下使用 EOS 成像系统对整个脊柱进行放射照相，研究了骨盆入射角、骶骨倾斜度、骨盆倾斜角、脊柱-骶骨角（SSA）和 Roussouly 分类中的 4 种背部类型。
研究人群的术前 SSA 值为 126.09°±8.45°，平均脊柱倾斜角为 90°，而健康受试者为 95°。手术后，椎间盘置换术的 SSA 显著增加，导致脊柱位置更加平衡。在接受 ALIF 技术融合术的患者组中，尽管使用了前凸笼，但没有发现明显的改善。我们表明，在骨盆入射角较低的情况下，必须保持 Roussouly 1 型或 2 型背部，而不增加前凸。结果表明，在这些患者中，L4-L5 椎间盘假体具有价值。对于骶骨倾斜度升高（背部类型 3 或 4）的患者，L5-S1 融合术似乎是一种更合适的治疗方法。这种新的矢状参数分析类型应在涉及腰椎假体的所有手术前进行。
