Ghandhari Hassan, Ameri Mahabadi Maryam, Nikouei Farshad, Sabbaghan Saeed, Azizi Abouzar, Mirzaei Alireza, Givehchian Behrooz
Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
Department of Forensic Medicine and Toxicology, Iran University of Medical Sciences, Tehran, Iran.
Arch Bone Jt Surg. 2018 Jul;6(4):324-330.
Sagittal imbalance is known as the main radiographic driver of disability in adult spinal deformity (ASD). In this study, the association of radiological spinopelvic parameters and clinical outcomes was evaluated following the corrective surgery of sagittal imbalance, in order to explore the predictive ability of each parameter.
A total of 23 patients, who underwent corrective osteotomy for restoration of sagittal balance, were included in this study. The mean follow-up period of the patients was 15.5±2.1, ranging from 12 to 18 months. Pre- and postoperative radiological parameters including pelvic tilt (PT), sagittal vertical axis (SVA) and pelvic incidence minus lumbar lordosis (PI-LL) were assessed for each patient. Clinical outcomes were evaluated using Oswestry disability Index (ODI).
The mean ODI improved 32% following the corrective osteotomy of sagittal imbalance. Postoperative ODI was significantly correlated with all preoperative radiological parameters (r=0.608, for PI-LL; r=0.483, for PT; and r=0.464, for SVA). ODI improvement was significantly correlated with PI-LL and SVA change (r=536, and r=416, , respectively), but not with PT change (r=247, ). The outcome was better in pedicle subtraction osteotomy (PSO) compared to Smith-Petersen Osteotomy (SPO).
Surgical correction of sagittal imbalance could limit the amount of disability caused by this misalignment. According to our results, while all the spinopelvic parameters could be used in the prediction of the outcomes of corrective surgery of sagittal imbalance, PI-LL was the most informative parameter and more attention should be devoted to this parameter.
矢状面失衡被认为是成人脊柱畸形（ASD）导致残疾的主要影像学因素。在本研究中，评估了矢状面失衡矫正手术后放射学脊柱骨盆参数与临床结果之间的关联，以探索每个参数的预测能力。
本研究纳入了23例行矫正截骨术以恢复矢状面平衡的患者。患者的平均随访期为15.5±2.1个月，范围为12至18个月。对每位患者术前和术后的放射学参数进行评估，包括骨盆倾斜度（PT）、矢状垂直轴（SVA）和骨盆入射角减去腰椎前凸角（PI-LL）。使用Oswestry功能障碍指数（ODI）评估临床结果。
矢状面失衡矫正截骨术后，平均ODI改善了32%。术后ODI与所有术前放射学参数均显著相关（PI-LL的r = 0.608；PT的r = 0.483；SVA的r = 0.464）。ODI改善与PI-LL和SVA的变化显著相关（分别为r = 0.536和r = 0.416），但与PT变化无关（r = 0.247）。与Smith-Petersen截骨术（SPO）相比，经椎弓根截骨术（PSO）的效果更好。
矢状面失衡的手术矫正可限制这种排列不齐导致的残疾程度。根据我们的结果，虽然所有脊柱骨盆参数均可用于预测矢状面失衡矫正手术的结果，但PI-LL是最具信息量的参数，应更多地关注该参数。
