腰椎融合术后下腰痛与腰椎矢状位对线的关系

[Relationship between low back pain and lumbar sagittal alignment after lumbar fusion].

作者信息

Hai Yong, Zhao Hui, Shao Nan, Lu Shi-bao, Yang Jin-cai, Liu Yu-zeng

机构信息

Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2013 Apr 16;93(15):1129-32.

PMID:23902879

Abstract

OBJECTIVE

To evaluate retrospectively the relationship between low back pain and changes of lumbar spine sagittal alignment after lumbar spine fusion.

METHODS

During January-December 2008, a total of 182 consecutive patients with degenerative lumbar spine diseases underwent posterior lumbar interbody fusion (PLIF) and the follow-up period was over 24 months. Standing lumbar spine anteroposterior and lateral radiography were taken during the follow-up and the lumbar lordosis Cobb angles were measured on radiography. Pain degrees were assessed by visual analog scale (VAS) and Oswestry disability index (ODI). The relationship between the changes of Cobb angle and lumbar sagittal plane curve was analyzed by the SPSS software. Also the relationship between back pain degree and Cobb angle was examined.

RESULTS

Among them, 42 cases with postoperative back pain were followed up for 24 months. There were 19 males and 23 females with a mean age of 59.6 years (range: 40 - 77). Lumbar spine sagittal Cobb angles were measured from radiographic images:lumbar lordosis angle: (1) mean angle at 12-month follow-up: 40.1° ± 10.6°, range: 20° - 60°; (2) mean angle at 24-month follow-up: 40.8° ± 10°, range: 24° - 60°. Back pain of 42 patients: VAS: (1) mean at 12-month follow-up: 29.4 ± 11.5, range: 5 - 50; (2) mean at 24-month follow-up: 27.6 ± 11.7, range: 25 - 48. Lumbar spine function of 42 patients: ODI: (1) mean at 12-month follow-up: 15.1 ± 5.4, range: 0 - 25; (2) mean at 24-month follow-up: 13.9 ± 5.2, range: 0 - 24. Difference between lumbar lordosis angle and standard score: (1) mean angle at 12-month follow-up: 19.9° ± 10.6°, range:0°-40°; (2) mean angle at 24-month follow-up:19.2° ± 10.0°, range:0°-36°. Angle difference versus back pain VAS: (1) at 12-month follow-up:P < 0.001, positive correlation; (2) 24-month follow-up: P < 0.001, positive correlation; angle difference versus back pain ODI: (1) 12-month follow-up:P < 0.001, positive correlation; (2) 24-month follow-up: P < 0.001, positive correlation.

CONCLUSION

There is a close relationship between back pain after fusion and loss of lumbar sagittal lordosis. And reconstruction of lumbar lordosis should be one important goal for lumbar fusion.

摘要

目的

回顾性评估腰椎融合术后下腰痛与腰椎矢状面排列变化之间的关系。

方法

2008年1月至12月期间，共有182例连续性退行性腰椎疾病患者接受了后路腰椎椎间融合术（PLIF），随访期超过24个月。随访期间拍摄站立位腰椎正侧位X线片，并在X线片上测量腰椎前凸Cobb角。采用视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）评估疼痛程度。使用SPSS软件分析Cobb角变化与腰椎矢状面曲线之间的关系。同时检查背痛程度与Cobb角之间的关系。

结果

其中42例术后背痛患者接受了24个月的随访。男性19例，女性23例，平均年龄59.6岁（范围：40 - 77岁）。从X线影像测量腰椎矢状面Cobb角：腰椎前凸角：（1）随访12个月时平均角度：40.1°±10.6°，范围：20° - 60°；（2）随访24个月时平均角度：40.8°±10°，范围：24° - 60°。42例患者的背痛：VAS：（1）随访12个月时平均值：29.4±11.5，范围：5 - 50；（2）随访24个月时平均值：27.6±11.7，范围：2 - 48。42例患者的腰椎功能：ODI：（1）随访12个月时平均值：15.1±5.4，范围：0 - 25；（2）随访24个月时平均值：13.9±5.2，范围：0 - 24。腰椎前凸角与标准值的差值：（1）随访12个月时平均角度：19.9°±10.6°，范围：0° - 40°；（2）随访24个月时平均角度：19.2°±10.0°，范围：0° - 36°。角度差值与背痛VAS的关系：（1）随访12个月时：P < 0.001，呈正相关；（2）随访24个月时：P < 0.001，呈正相关；角度差值与背痛ODI的关系：（1）随访12个月时：P < 0.001，呈正相关；（2）随访24个月时：P < 0.001，呈正相关。