Greimel Felix, Wolkerstorfer Stefanie, Spörrer Jan-Frederik, Zeman Florian, Hoffstetter Patrick, Grifka Joachim, Benditz Achim
Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
Center for Clinical Studies, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
Arch Orthop Trauma Surg. 2017 Oct;137(10):1319-1325. doi: 10.1007/s00402-017-2755-2. Epub 2017 Jul 11.
Aim of this study is to show the outcome of postoperatively measured lumbar lordosis in upright position in comparison to the intraoperatively estimated lumbar lordosis in prone position, as the lumbar lordosis is one of the most important factors for the clinical outcome after spinal fusion.
Eighty-two patients, receiving lumbar fusion were included in this retrospective study. Intraoperative radiographs were scanned. Then radiographs of the whole spine pre- and postoperatively, as well as 1 year after surgery were measured by a spine surgeon and a radiologist. The visible segment lordosis angles were measured and compared (L2-S1, L3-S1, L4-S1, L5-S1). In addition, the pelvic parameters pelvic incidence, pelvic tilt and sacral slope were measured pre- and postoperatively.
The intraobserver reliability was almost perfect. The mean lordosis angle L4-S1 was 32.6° ± 7.8° intraoperatively and 29° ± 10.8° postoperatively. A linear correlation of these two measurements can be seen. In mean, the postoperative lordosis is 4° smaller than intraoperatively. This trend can also be seen in the level L3-S1. In levels L2-S1 and L5-S1 the postoperative values were slightly higher than intraoperatively, but without any significance. Also, 1 year after surgery there were no significant changes in global lumbar lordosis.
Measuring lordosis angles intraoperatively resulted in almost the same values as measurements in standing plane radiographs postoperatively, despite prone position. These findings could especially be shown for the level L4-S1. The intraobserver reliability was almost perfect for both, intra- and postoperative measurements. In conclusion, the intraoperative measurement of a lumbar lordosis angle can perfectly predict the postoperative result.
本研究旨在比较腰椎融合术后直立位测量的腰椎前凸与术中俯卧位估计的腰椎前凸结果，因为腰椎前凸是脊柱融合术后临床结果的最重要因素之一。
本回顾性研究纳入了82例行腰椎融合术的患者。术中X线片进行扫描。然后由脊柱外科医生和放射科医生测量术前、术后以及术后1年的全脊柱X线片。测量并比较可见节段的前凸角度（L2-S1、L3-S1、L4-S1、L5-S1）。此外，术前和术后测量骨盆参数骨盆入射角、骨盆倾斜度和骶骨斜率。
观察者内信度几乎完美。术中L4-S1平均前凸角度为32.6°±7.8°，术后为29°±10.8°。这两个测量值之间存在线性相关性。平均而言，术后前凸比术中小4°。在L3-S1水平也可见此趋势。在L2-S1和L5-S1水平，术后值略高于术中，但无统计学意义。而且，术后1年全腰椎前凸无明显变化。
尽管是俯卧位，但术中测量前凸角度与术后站立位X线片测量结果几乎相同。这一发现尤其在L4-S1水平得到证实。观察者内信度对于术中及术后测量均几乎完美。总之，术中测量腰椎前凸角度可完美预测术后结果。
