一种腰椎退行性椎体滑脱的新分类系统。
A new classification system for degenerative spondylolisthesis of the lumbar spine.
作者信息
Gille Olivier, Bouloussa Houssam, Mazas Simon, Vergari Claudio, Challier Vincent, Vital Jean-Marc, Coudert Pierre, Ghailane Soufiane
机构信息
Department of Spinal Surgery Unit 1, C.H.U Tripode Pellegrin, Bordeaux University Hospital, Université de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France.
School of Physics and Astronomy, University of Exeter, Exeter, UK.
出版信息
Eur Spine J. 2017 Dec;26(12):3096-3105. doi: 10.1007/s00586-017-5275-4. Epub 2017 Aug 23.
PURPOSE
There is no consensus for a comprehensive analysis of degenerative spondylolisthesis of the lumbar spine (DSLS). A new classification system for DSLS based on sagittal alignment was proposed. Its clinical relevance was explored.
METHODS
Health-related quality-of-life scales (HRQOLs) and clinical parameters were collected: SF-12, ODI, and low back and leg pain visual analog scales (BP-VAS, LP-VAS). Radiographic analysis included Meyerding grading and sagittal parameters: segmental lordosis (SL), L1-S1 lumbar lordosis (LL), T1-T12 thoracic kyphosis (TK), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis (SVA). Patients were classified according to three main types-1A: preserved LL and SL; 1B: preserved LL and reduced SL (≤5°); 2A: PI-LL ≥10° without pelvic compensation (PT < 25°); 2B: PI-LL ≥10° with pelvic compensation (PT ≥ 25°); type 3: global sagittal malalignment (SVA ≥40 mm).
RESULTS
166 patients (119 F: 47 M) suffering from DSLS were included. Mean age was 67.1 ± 11 years. DSLS demographics were, respectively: type 1A: 73 patients, type 1B: 3, type 2A: 8, type 2B: 22, and type 3: 60. Meyerding grading was: grade 1 (n = 124); grade 2 (n = 24). Affected levels were: L4-L5 (n = 121), L3-L4 (n = 34), L2-L3 (n = 6), and L5-S1 (n = 5). Mean sagittal parameter values were: PI: 59.3° ± 11.9°; PT: 24.3° ± 7.6°; SVA: 29.1 ± 42.2 mm; SL: 18.2° ± 8.1°. DSLS types were correlated with age, ODI and SF-12 PCS (ρ = 0.34, p < 0.05; ρ = 0.33, p < 0.05; ρ = -0.20, and p = 0.01, respectively).
CONCLUSION
This classification was consistent with age and HRQOLs and could be a preoperative assessment tool. Its therapeutic impact has yet to be validated.
LEVEL OF EVIDENCE
目的
对于腰椎退行性椎体滑脱（DSLS）的综合分析尚无共识。提出了一种基于矢状位对线的DSLS新分类系统，并探讨其临床相关性。
方法
收集与健康相关的生活质量量表（HRQOLs）和临床参数：SF-12、ODI以及腰腿痛视觉模拟量表（BP-VAS、LP-VAS）。影像学分析包括迈耶丁分级和矢状位参数：节段性前凸（SL）、L1-S1腰椎前凸（LL）、T1-T12胸椎后凸（TK）、骨盆入射角（PI）、骨盆倾斜度（PT）和矢状垂直轴（SVA）。患者根据三种主要类型进行分类 - 1A：LL和SL保留；1B：LL保留且SL减小（≤5°）；2A：PI-LL≥10°且无骨盆代偿（PT < 25°）；2B：PI-LL≥10°且有骨盆代偿（PT≥25°）；3型：整体矢状位排列不齐（SVA≥40mm）。
结果
纳入166例患有DSLS的患者（119例女性：47例男性）。平均年龄为67.1±11岁。DSLS的人口统计学数据分别为：1A 型：73例患者，1B 型：3例，2A 型：8例，2B 型：22例，3型：60例。迈耶丁分级为：1级（n = 124）；2级（n = 24）。受累节段为：L4-L5（n = 121），L3-L4（n = 34），L2-L3（n = 6），L5-S1（n = 5）。矢状位参数的平均值为：PI：59.3°±11.9°；PT：24.3°±7.6°；SVA：29.1±42.2mm；SL：18.2°±8.1°。DSLS类型与年龄、ODI和SF-12 PCS相关（ρ分别为0.34，p < 0.05；ρ为0.33，p < 0.05；ρ为 - 0.20，p = 0.01）。
结论
该分类与年龄和HRQOLs一致，可能是一种术前评估工具。其治疗影响尚待验证。
证据级别
4级。
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