Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA.
Eur Spine J. 2020 Apr;29(4):821-830. doi: 10.1007/s00586-019-06255-z. Epub 2020 Jan 28.
Three-column osteotomies at L5 or the sacrum (LS3COs) are technically challenging, yet they may be needed to treat lumbosacral kyphotic deformities. We investigated radiographic and clinical outcomes after LS3CO.
We analyzed 25 consecutive patients (mean age 56 years) who underwent LS3CO with minimum 2-year follow-up. Standing radiographs and health-related quality-of-life scores were evaluated. A new radiographic parameter ["lumbosacral angle" (LSA)] was introduced to evaluate sagittal alignment distal to the S1 segment.
From preoperatively to the final follow-up, significant improvements occurred in lumbar lordosis (from - 34° to - 49°), LSA (from 0.5° to 22°), and sagittal vertical axis (SVA) (from 18 to 7.3 cm) (all, p < .01). Mean Scoliosis Research Society (SRS)-22r scores in activity, pain, self-image, and satisfaction (p < .05), and Oswestry Disability Index scores (p < .01) also improved significantly. Patients with SVA ≥ 5 cm at the final follow-up experienced less improvement in SRS-22r satisfaction scores than those with SVA < 5 cm. Patients with LSA < 20° at the final follow-up had significantly lower SRS-22r activity scores than those with LSA ≥ 20° (p = .014). Two patients had transient neurologic deficits, and 11 patients underwent revision for proximal junctional kyphosis (5), pseudarthrosis (3), junctional stenosis (2), or neurologic deficit (1).
LS3CO produced radiographic and clinical improvements. However, patients who remained sagittally imbalanced had less improvement in SRS-22r satisfaction score than those whose sagittal imbalance was corrected, and patients who maintained kyphotic deformity in the lumbosacral spine had lower SRS-22r activity scores than those whose lumbosacral kyphosis was corrected. These slides can be retrieved under Electronic Supplementary Material.
L5 或骶骨的三柱截骨术（LS3COs）技术难度大，但对于治疗腰骶脊柱后凸畸形可能是必要的。我们研究了 LS3CO 后的影像学和临床结果。
我们分析了 25 例连续接受 LS3CO 治疗且随访时间至少 2 年的患者（平均年龄 56 岁）。评估站立位 X 线片和与健康相关的生活质量评分。引入新的影像学参数“腰骶角”（LSA）来评估 S1 节段以下的矢状位对线。
从术前到最终随访，腰椎前凸角（从-34°到-49°）、LSA（从 0.5°到 22°）和矢状垂直轴（SVA）（从 18 到 7.3cm）均有显著改善（均 p<0.01）。SRS-22r 评分中的活动、疼痛、自我形象和满意度（p<0.05）以及 Oswestry 残疾指数评分（p<0.01）也显著改善。在最终随访时 SVA≥5cm 的患者，其 SRS-22r 满意度评分改善程度低于 SVA<5cm 的患者。最终随访时 LSA<20°的患者 SRS-22r 活动评分显著低于 LSA≥20°的患者（p=0.014）。2 例患者出现短暂性神经功能障碍，11 例患者行近端交界性后凸（5 例）、假关节（3 例）、交界性狭窄（2 例）或神经功能障碍（1 例）翻修。
LS3CO 可改善影像学和临床结果。然而，矢状位仍不平衡的患者，其 SRS-22r 满意度评分改善程度低于矢状位得到纠正的患者，腰骶脊柱后凸畸形仍存在的患者，其 SRS-22r 活动评分低于腰骶脊柱后凸得到纠正的患者。这些幻灯片可以在电子补充材料中找到。
