Regional Department of Spinal Surgery, Ospedale De Lellis, Aziendale ULSS 4, Via S.C. De Lellis 1, Schio 36015, Alto Vicentino, Italy.
J Clin Neurosci. 2013 Apr;20(4):576-81. doi: 10.1016/j.jocn.2012.05.032. Epub 2013 Jan 30.
There is increasing interest in the use of pelvic indices to evaluate sagittal balance and predict outcomes in patients with spinal disease. Conventional posterior lumbar fusion techniques may adversely affect lumbar lordosis and spinal balance. Minimally invasive fusion of the lumbar spine is rapidly becoming a mainstay of treatment of lumbar degenerative disc disease. To our knowledge there are no studies evaluating the effect of extreme lateral interbody fusion (XLIF) on pelvic indices. Hence, our aim was to study the effect of XLIF on pelvic indices related to sagittal balance, and report the results of a prospective longitudinal clinical study and retrospective radiographic analyses of patients undergoing XLIF in a single centre between January 2009 and July 2011. Clinical outcomes are reported for 30 patients and the retrospective analyses of radiographic data is reported for 22 of these patients to assess global and segmental lumbar lordosis and pelvic indices. Effect of XLIF on the correction of scoliotic deformity was assessed in 15 patients in this series. A significant improvement was seen in the visual analogue scale score, the Oswestry Disability Index and the Short Form-36 at 2months and 6months (p<0.0001). The mean pelvic index was 48.6°±11.9° (± standard deviation, SD) with corresponding mean sacral slopes and pelvic tilt of 32.0°±10.6° (SD) and 18.0°±9.5 (SD), respectively. XLIF did not significantly affect sacral slope or pelvic tilt (p>0.2). Global lumbar lordosis was not affected by XLIF (p>0.4). XLIF significantly increased segmental lumbar lordosis by 3.3° (p<0.0001) and significantly decreased the scoliotic Cobb angle by 5.9° (p=0.01). We found that XLIF improved scoliosis and segmental lordosis and was associated with significant clinical improvement in patients with lumbar degenerative disc disease. However, XLIF did not change overall lumbar lordosis or significantly alter pelvic indices associated with sagittal balance. Long-term follow-up with a larger cohort will be required to further evaluate the effects of XLIF on sagittal balance.
人们对使用骨盆指数评估脊柱疾病患者矢状位平衡和预测结果的兴趣日益浓厚。传统的后路腰椎融合技术可能会对腰椎前凸和脊柱平衡产生不利影响。微创腰椎融合术迅速成为治疗腰椎退行性椎间盘疾病的主要方法。据我们所知，目前还没有研究评估极外侧椎间融合术（XLIF）对骨盆指数的影响。因此，我们的目的是研究 XLIF 对与矢状位平衡相关的骨盆指数的影响，并报告 2009 年 1 月至 2011 年 7 月在一家中心进行 XLIF 的前瞻性纵向临床研究和回顾性放射学分析的结果。报告了 30 例患者的临床结果，并对其中 22 例患者的放射学数据进行了回顾性分析，以评估整体和节段性腰椎前凸和骨盆指数。在本系列中，评估了 15 例脊柱侧凸患者 XLIF 对矫正畸形的影响。在 2 个月和 6 个月时，视觉模拟量表评分、Oswestry 残疾指数和 36 项简短健康调查评分均显著改善（p<0.0001）。平均骨盆指数为 48.6°±11.9°（±标准差，SD），相应的平均骶骨斜率和骨盆倾斜度分别为 32.0°±10.6°（SD）和 18.0°±9.5°（SD）。XLIF 对骶骨斜率或骨盆倾斜度没有显著影响（p>0.2）。XLIF 对整体腰椎前凸没有影响（p>0.4）。XLIF 显著增加了 3.3°的节段性腰椎前凸（p<0.0001），并显著降低了 5.9°的脊柱侧凸 Cobb 角（p=0.01）。我们发现，XLIF 改善了脊柱侧凸和节段性前凸，并与腰椎退行性椎间盘疾病患者的显著临床改善相关。然而，XLIF 并没有改变整体腰椎前凸或显著改变与矢状位平衡相关的骨盆指数。需要进行长期随访，以更大的队列进一步评估 XLIF 对矢状位平衡的影响。
