Department of Regenerative and Transplant Medicine, Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences.
Department of Orthopedic Surgery, Spine Center, Niigata Central Hospital, Niigata, Japan.
Clin Spine Surg. 2020 Dec;33(10):E504-E511. doi: 10.1097/BSD.0000000000001013.
This was a retrospective case control study.
The objective was to determine the impact of single-level interbody fusion at L4/5 with or without concomitant decompression on various spinopelvic parameters and health-related quality-of-life (HRQOL) outcomes.
Recently, focus has swayed from a regional concern to a global sagittal alignment, more comprehensive approach in multilevel, corrective fusion for adult spinal deformity. However, only a few comprehensive studies have investigated the relationships between the various related spinopelvic parameters and HRQOL outcomes using single-level interbody fusion.
In total, 119 patients with lumbar degenerative disorders (mean age, 68 y; 38 males and 81 females) who underwent L4/5 single-level posterior interbody fusion with a minimum 2-year follow-up were included. Participants were divided into 2 groups according to preoperative sagittal modifiers of the SRS-Schwab adult spinal deformity classification. The correlation between spinopelvic parameters and HRQOL outcomes was investigated. Negative or positive values indicated lordosis. HRQOL outcomes were assessed using visual analog scale scores, Japanese Orthopedic Association Back Pain Evaluation Questionnaires (JOABPEQ), and short form-36 (SF-36).
L4/5 local lordosis increased from 6.4±4.4 degrees preoperatively to 11.3±4.5 degrees at 2 years postoperatively (P<0.0001). Further analysis of the results also showed a correlation between change in L4/5 local lordosis and change in lumbar lordosis (LL) (rs=0.229, P=0.0143). The high pelvic incidence-LL (≥20 degrees, n=28) and high sagittal vertical axis groups (≥5 cm, n=29) had lower scores in walking ability, social life domains of JOABPEQ, and physical component summary scores of SF-36 preoperatively, and 2 years postoperatively. Fusion status did not affect the HRQOL outcomes, except that concomitant decompression at the adjacent disk level yielded lower SF-36 physical component summary scores 2 years postoperatively.
Improvement in L4/5 local lordosis possibly triggers a simultaneous sequence of change in total LL after posterior single-level fusion. HRQOL outcomes were negatively affected by both preoperative and postoperative pelvic incidence-LL mismatch and global sagittal malalignment.
Level III.
这是一项回顾性病例对照研究。
旨在确定单节段 L4/5 椎体间融合术联合或不联合减压对各种脊柱骨盆参数和健康相关生活质量（HRQOL）结果的影响。
最近，人们的关注点已经从区域性问题转移到了整体矢状位排列，对于成人脊柱畸形的多节段、矫正性融合，采用了更全面的方法。然而，只有少数综合研究使用单节段椎体间融合术调查了各种相关脊柱骨盆参数与 HRQOL 结果之间的关系。
共纳入 119 例腰椎退行性疾病患者（平均年龄 68 岁；男性 38 例，女性 81 例），均接受 L4/5 单节段后路椎体间融合术，随访时间至少 2 年。根据 SRS-Schwab 成人脊柱畸形分类的术前矢状面修正标准，将患者分为 2 组。研究人员调查了脊柱骨盆参数与 HRQOL 结果之间的相关性。负值或正值表示前凸。HRQOL 结果采用视觉模拟评分量表、日本矫形协会腰痛评估问卷（JOABPEQ）和健康调查简表 36（SF-36）进行评估。
L4/5 局部前凸从术前的 6.4°±4.4°增加到术后 2 年的 11.3°±4.5°（P<0.0001）。进一步分析结果还显示，L4/5 局部前凸的变化与腰椎前凸（LL）的变化之间存在相关性（rs=0.229，P=0.0143）。骨盆入射角-LL 差值较大（≥20°，n=28）和矢状位垂直轴差值较大（≥5cm，n=29）的患者术前 JOABPEQ 的行走能力和社会生活领域以及 SF-36 的生理成分总分评分较低，术后 2 年时也是如此。融合状态并未影响 HRQOL 结果，但相邻节段减压会导致术后 2 年 SF-36 生理成分总分评分较低。
后路单节段融合术后，L4/5 局部前凸的改善可能引发总 LL 同时发生一系列变化。骨盆入射角-LL 不匹配和整体矢状位失平衡对 HRQOL 结果产生负面影响。
III 级。
