Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Spine Center, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gandong-gu, Seoul, 05278, South Korea.
BMC Musculoskelet Disord. 2020 Nov 12;21(1):740. doi: 10.1186/s12891-020-03755-8.
There is a paucity of reports clarifying the implication of knee osteoarthritis (OA) on spinal sagittal alignment of patients undergone surgery for lumbar spine. This study aimed to analyze how osteoarthritic knee affects radiographic and clinical results of degenerative lumbar disease patients undergone lumbar fusion.
We retrospectively reviewed the medical records and radiographs of 74 consecutive degenerative lumbar disease patients who underwent posterior instrumentation and fusion surgery between May 2016 and June 2017 and were followed up for minimum 3 years postoperatively. The patients were divided into 2 groups according to the severity of knee OA by Kellgren-Lawrence grading (KLG) scale (group I, KLG 1 or 2 [n = 39]; group II, KLG 3 or 4 [n = 35]). Patient demographic data, comorbidities, spinal sagittal parameters and clinical scores were extracted and compared at preoperative, postoperative 1 month and the ultimate follow-up between the groups. In radiographic assessment, sagittal alignment parameters and sagittal balance were used. In clinical assessment, the scores of Oswestry disability index (ODI) and Scoliosis Research Society questionnaire (SRS-22) were used. For the frequency analysis of categorical variables across the groups, chi-square test was used and student t tests was used to compare the differences of continuous variables.
In radiographic assessment, TLK (thoracolumbar kyphosis), LL (lumbar lordosis), PT (pelvic tilt), C7 SVA (sagittal vertical axis) in both groups improved significantly after surgery (p < 0.05). However, LL, PT, C7SVA improved at postoperative 1 month in the group II were not maintained at the ultimate postoperative follow-up. In clinical assessment, preoperative Oswestry disability index (ODI, %) and all SRS-22 subscores of the group I and II were not different (p > 0.05). There were significant differences between the groups at the ultimate follow-up in ODI (- 25.6 vs - 12.1, p < 0.001), SRS total score (%) (28 vs 20, p = 0.037), function subscore (1.4 vs 0.7, p = 0.016), and satisfaction subscore (1.6 vs 0.6, p < 0.001).
Osteoarthritic knee with KLG 3 or 4 have a negative influence on maintaining postoperative spinal sagittal alignment, balance, and the clinical outcomes achieved immediately by posterior instrumentation and fusion for lumbar degenerative disease.
This study was retrospectively registered with approval by the institutional review board (IRB) of our institution (approval number: 2018-11-007).
目前鲜有研究阐明膝关节骨关节炎（OA）对接受腰椎手术患者脊柱矢状位排列的影响。本研究旨在分析膝关节 OA 对接受腰椎融合术的退变性腰椎疾病患者的放射学和临床结果的影响。
我们回顾性分析了 2016 年 5 月至 2017 年 6 月期间接受后路器械固定融合术的 74 例连续退变性腰椎疾病患者的病历和影像学资料，所有患者术后均随访至少 3 年。根据 Kellgren-Lawrence 分级（KLG）量表（KLG 1 或 2 级[ n = 39]；KLG 3 或 4 级[ n = 35]）将患者分为 2 组。比较两组患者的术前、术后 1 个月和最终随访时的患者人口统计学数据、合并症、脊柱矢状位参数和临床评分。在放射学评估中，使用矢状面参数和矢状面平衡进行评估。在临床评估中，使用 Oswestry 残疾指数（ODI）和脊柱侧凸研究协会问卷（SRS-22）评分进行评估。对于组间分类变量的频率分析，使用卡方检验，对于连续变量的差异，使用学生 t 检验进行比较。
在放射学评估中，两组的 TLK（胸腰椎后凸）、LL（腰椎前凸）、PT（骨盆倾斜）和 C7 SVA（矢状垂直轴）在术后均显著改善（ p < 0.05）。然而，组 II 的 LL、PT 和 C7SVA 在术后 1 个月改善，但在最终术后随访时并未维持。在临床评估中，组 I 和组 II 的术前 ODI（%）和所有 SRS-22 亚评分无差异（ p > 0.05）。在最终随访时，组间 ODI（-25.6 比-12.1， p < 0.001）、SRS 总分（%）（28 比 20， p = 0.037）、功能亚评分（1.4 比 0.7， p = 0.016）和满意度亚评分（1.6 比 0.6， p < 0.001）差异有统计学意义。
KLG 3 或 4 级的膝关节骨关节炎对接受腰椎退行性疾病后路器械固定融合术的患者术后脊柱矢状面排列、平衡和即刻临床结果有负面影响。
本研究经机构审查委员会（IRB）批准后进行了回顾性登记（注册号：2018-11-007）。
