Radovanovic Ingrid, Urquhart Jennifer C, Ganapathy Venkat, Siddiqi Fawaz, Gurr Kevin R, Bailey Stewart I, Bailey Christopher S
Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry, Western University.
London Health Science Centre, London, Ontario, Canada.
J Neurosurg Spine. 2017 Apr;26(4):448-453. doi: 10.3171/2016.9.SPINE1680. Epub 2017 Jan 20.
OBJECTIVE The object of this study was to determine the association between postoperative sagittal spinopelvic alignment and patient-rated outcome measures following decompression and fusion for lumbar degenerative spondylolisthesis. METHODS The authors identified a consecutive series of patients who had undergone surgery for lumbar degenerative spondylolisthesis between 2008 and 2012, with an average follow-up of 3 years (range 1-6 years). Surgery was performed to address the clinical symptoms of spinal stenosis, not global sagittal alignment. Sagittal alignment was only assessed postoperatively. Patients were divided into 2 groups based on a postoperative sagittal vertical axis (SVA) < 50 mm (well aligned) or ≥ 50 mm (poorly aligned). Baseline demographic, procedure, and outcome measures were compared between the groups. Postoperative outcome measures and postoperative spinopelvic parameters were compared between groups using analysis of covariance. RESULTS Of the 84 patients included in this study, 46.4% had an SVA < 50 mm. Multiple levels of spondylolisthesis (p = 0.044), spondylolisthesis at the L3-4 level (p = 0.046), and multiple levels treated with fusion (p = 0.028) were more common among patients in the group with an SVA ≥ 50 mm. Patients with an SVA ≥ 50 mm had a worse SF-36 physical component summary (PCS) score (p = 0.018), a worse Oswestry Disability Index (ODI; p = 0.043), and more back pain (p = 0.039) than those with an SVA < 50 mm after controlling for multiple levels of spondylolisthesis and multilevel fusion. The spinopelvic parameters differing between the < 50-mm and ≥ 50-mm groups included lumbar lordosis (LL; 56.4° ± 4.7° vs 49.8° ± 4.3°, respectively, p = 0.040) and LL < pelvic incidence ± 9° (51% vs 23.1%, respectively, p = 0.013) after controlling for type of surgical procedure. CONCLUSIONS Data in this study revealed that patient-rated outcome is influenced by the overall postoperative sagittal balance as defined by the SVA.
目的 本研究的目的是确定腰椎退行性滑脱减压融合术后矢状位脊柱骨盆对线与患者自评结局指标之间的关联。方法 作者纳入了2008年至2012年间连续接受腰椎退行性滑脱手术的一系列患者，平均随访3年（范围1 - 6年）。手术旨在解决椎管狭窄的临床症状，而非整体矢状位对线。矢状位对线仅在术后进行评估。根据术后矢状垂直轴（SVA）< 50 mm（对线良好）或≥ 50 mm（对线不良）将患者分为两组。比较两组的基线人口统计学、手术情况和结局指标。使用协方差分析比较两组的术后结局指标和术后脊柱骨盆参数。结果 本研究纳入的84例患者中，46.4%的患者SVA < 50 mm。SVA≥ 50 mm组患者中，多节段滑脱（p = 0.044）、L3 - 4节段滑脱（p = 0.046）以及多节段融合治疗（p = 0.028）更为常见。在控制多节段滑脱和多节段融合后，SVA≥ 50 mm的患者的SF - 36身体成分总结（PCS）评分更差（p = 0.018），Oswestry功能障碍指数（ODI；p = 0.043）更差，背痛更严重（p = 0.039）。在控制手术方式后，< 50 mm组和≥ 50 mm组之间不同的脊柱骨盆参数包括腰椎前凸（LL；分别为56.4°± 4.7°和49.8°± 4.3°，p = 0.040）以及LL <骨盆入射角± 9°（分别为51%和23.1%，p = 0.013）。结论 本研究数据表明，患者自评结局受SVA定义的术后整体矢状位平衡的影响。
