Department of Orthopaedic Surgery, Orthopaedic Spine Center, Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Department of Orthopaedic Surgery, Orthopaedic Spine Center, Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Spine J. 2019 Oct;19(10):1606-1612. doi: 10.1016/j.spinee.2019.05.012. Epub 2019 May 21.
En bloc resection and reconstruction (EBR) in patients with spinal malignancy aims to achieve local disease control. This is an invasive procedure with significant alterations of the physiological anatomy and subsequently, the spino-pelvic alignment. Sagittal spinal parameters are useful measurements to objectively identify disproportionate alignment on a radiograph. In the field of spinal deformities, there is increasing evidence for a relationship between sagittal alignment and patient reported outcomes.
To determine sagittal spino-pelvic alignment after EBR in patients with spinal malignancies and the effect of these parameters on surgical and patient reported outcomes.
A retrospective case series.
We included 35 patients who underwent EBR for spinal malignancies between 2000 and 2018. Radiographic measurements were performed using semi-automatic software; the parameters included were pelvic incidence (PI), sacral slope, pelvic tilt (PT), global tilt and lumbar lordosis. We calculated PI-based Global Alignment and Proportion (GAP) scores and prospective patient reported outcome scores Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF) were used.
Twenty-one (60%) patients filled out the PROMIS-PF score at a median of 16 months (Interquartile Range (IQR) 4-108) after surgery with a median score of 39 (IQR 32-42), the median GAP score was 7 (IQR 5-9). Bivariate analysis showed no statistically significant relationship between GAP score and instrumentation failure or need for revision surgery. Multivariable analysis of GAP score and PROMIS-PF score corrected for local disease recurrence showed a statistically significant correlation coefficient of -1.721 (p=.026; 95%CI=-3.216, -0.226).
In this cohort, all patients had a moderate or severe disproportioned spinal alignment after EBR and reconstruction surgery. The degree of sagittal spino-pelvic misalignment after EBR for spinal malignancies seems to be associated with patient reported health status in terms of PROMIS-PF scores. Further research with a larger patient cohort and standardized imaging and follow-up protocols is necessary in order to accurately use sagittal alignment as a predictive value for instrumentation failure and revision surgery.
在患有脊柱恶性肿瘤的患者中，整块切除术和重建（EBR）旨在实现局部疾病控制。这是一种具有显著改变生理解剖结构的侵袭性手术，随后会导致脊柱骨盆排列的改变。矢状位脊柱参数是一种有用的测量方法，可以客观地识别 X 光片上不成比例的排列。在脊柱畸形领域，越来越多的证据表明矢状位排列与患者报告的结果之间存在关系。
确定脊柱恶性肿瘤患者接受 EBR 后的矢状位脊柱骨盆排列情况，以及这些参数对手术和患者报告结果的影响。
回顾性病例系列研究。
我们纳入了 2000 年至 2018 年间接受 EBR 治疗脊柱恶性肿瘤的 35 名患者。使用半自动软件进行放射学测量；所包括的参数包括骨盆入射角（PI）、骶骨倾斜度、骨盆倾斜度（PT）、整体倾斜度和腰椎前凸度。我们计算了基于 PI 的全局对准和比例（GAP）评分，并使用前瞻性患者报告结局测量信息系统-物理功能（PROMIS-PF）评分。
21 名（60%）患者在手术后中位数为 16 个月（四分位距（IQR）4-108）时填写了 PROMIS-PF 评分，中位数为 39（IQR 32-42），中位数 GAP 评分为 7（IQR 5-9）。Bivariate 分析显示，GAP 评分与器械失败或需要翻修手术之间无统计学显著关系。校正局部疾病复发后，GAP 评分和 PROMIS-PF 评分的多变量分析显示，相关系数为-1.721（p=.026；95%CI=-3.216，-0.226）。
在本队列中，所有患者在 EBR 和重建手术后均存在中度或重度不成比例的脊柱排列。脊柱恶性肿瘤 EBR 后矢状位脊柱骨盆失配的程度似乎与患者报告的健康状况（以 PROMIS-PF 评分表示）有关。为了准确地将矢状位排列用作器械失败和翻修手术的预测值，需要进行具有更大患者队列和标准化成像及随访方案的进一步研究。
