Department of Neurosurgery, Univer-sity of South Florida, Tampa, Florida.
Department of Neurosurgery, Univer-sity of Miami, Miami, Florida.
Neurosurgery. 2018 Aug 1;83(2):270-276. doi: 10.1093/neuros/nyx383.
Pelvic tilt (PT) is a compensatory mechanism for adult spinal deformity patients to mitigate sagittal imbalance. The association between preop PT and postop clinical and radiographic outcomes has not been well studied in patients undergoing minimally invasive adult deformity surgery.
To evaluate clinical and radiographic outcomes in adult spinal deformity patients with high and low preoperative PT treated surgically using less invasive techniques.
Retrospective case-control, institutional review board-approved study. A multicenter, minimally invasive surgery spinal deformity patient database was queried for 2-yr follow-up with complete radiographic and health-related quality of life (HRQOL) data. Hybrid surgery patients were excluded. Inclusion criteria were as follows: age > 18 and either coronal Cobb angle > 20, sagittal vertical axis > 5 cm, pelvic incidence-lumbar lordosis (PI-LL) > 10 or PT > 20. Patients were stratified by preop PT as per Schwab classification: low (PT< 20), mid (PT 20-30), or high (>30). Postoperative radiographic alignment parameters (PT, PI, LL, Cobb angle, sagittal vertical axis) and HRQOL data (Visual Analog Scale Back/Leg, Oswestry Disability Index) were evaluated and analyzed.
One hundred sixty-five patients had complete 2-yr outcomes data, and 64 patients met inclusion criteria (25 low, 21 mid, 18 high PT). High PT group had higher preop PI-LL mismatch (32.1 vs 4.7; P < .001). At last follow-up, 76.5% of patients in the high PT group had continued PI-LL mismatch compared to 34.8% in the low PT group (P < .006). There was a difference between groups in terms of postop changes of PT (-3.9 vs 1.9), LL (8.7 vs 0.5), and PI-LL (-9.5 vs 0.1). Postoperatively, HRQOL data (Oswestry Disability Index and Visual Analog Scale) were significantly improved in both groups (P < .001).
Adult deformity patients with high preoperative PT treated with minimally invasive surgical techniques had less radiographic success but equivalent clinical outcomes as patients with low PT.
骨盆倾斜（PT）是成人脊柱畸形患者缓解矢状面失衡的代偿机制。在接受微创成人脊柱畸形手术的患者中，术前 PT 与术后临床和影像学结果之间的关系尚未得到很好的研究。
评估使用微创技术治疗的术前 PT 较高和较低的成人脊柱畸形患者的临床和影像学结果。
回顾性病例对照、机构审查委员会批准的研究。对多中心微创脊柱畸形患者数据库进行了为期 2 年的随访，以获取完整的影像学和健康相关生活质量（HRQOL）数据。排除混合手术患者。纳入标准如下：年龄> 18 岁，冠状 Cobb 角> 20°，矢状垂直轴> 5cm，骨盆入射角-腰椎前凸（PI-LL）> 10°或 PT> 20°。根据 Schwab 分类，患者按术前 PT 分为低（PT< 20）、中（PT 20-30）或高（>30）。评估和分析术后影像学对线参数（PT、PI、LL、Cobb 角、矢状垂直轴）和 HRQOL 数据（视觉模拟量表背部/腿部、Oswestry 残疾指数）。
165 例患者有完整的 2 年结局数据，64 例符合纳入标准（25 例低 PT，21 例中 PT，18 例高 PT）。高 PT 组术前 PI-LL 不匹配更高（32.1 比 4.7；P <.001）。在最后一次随访时，与低 PT 组的 34.8%相比，高 PT 组 76.5%的患者仍存在 PI-LL 不匹配（P <.006）。两组间 PT（-3.9 比 1.9）、LL（8.7 比 0.5）和 PI-LL（-9.5 比 0.1）的术后变化存在差异。两组术后 HRQOL 数据（Oswestry 残疾指数和视觉模拟量表）均显著改善（P <.001）。
接受微创手术技术治疗的术前高 PT 成人脊柱畸形患者影像学成功率较低，但与低 PT 患者的临床结果相当。
