Asaid Mina, Cox Aram, Breslin Monique, Siedler Declan, Sutterlin Chester, Dubey Arvind
Department of Neurosurgery, Royal Hobart Hospital, TAS, Australia.
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
J Spine Surg. 2020 Dec;6(4):639-649. doi: 10.21037/jss-20-605.
The importance of spinopelvic harmony [pelvic incidence (PI) = lumbar lordosis (LL) ±10 degrees] is well established in the literature. We aimed to determine whether lateral lumbar interbody fusion (LLIF) surgery in isolation is successful in restoring spinopelvic harmony, and whether the surgery maintained the relationship in those who present in a balanced state.
A retrospective radiographic analysis was performed on patients who underwent LLIF surgery, followed by posterior instrumented fusion, between January 2012 to August 2019 by a single surgeon (AD). Pre- and post-operative X-rays were reviewed by two authors using Surgimap spinal imaging 2.2.15.5. The LL, PI, and PI-LL mismatch, as well as a range of coronal and segmental sagittal radiographic parameters, were recorded.
A total of 71 patients with 170 levels treated via LLIF were analysed. A mean pre-operative PI-LL of 14.3 degrees and post-operative value of 13.4 degrees was recorded (P=0.43). Of the 41 patients who were imbalanced pre-operatively, 13 (31.7%) were restored to a LL within 10 degrees of PI post-LLIF procedure. 30 patients presented in spinopelvic harmony, and 25 (83.3%) of those maintained that relationship following LLIF. Mean coronal global Cobb angles (13.7 degrees pre-operatively to 7.7 degrees post-operatively), segmental coronal Cobb angles (3.8 to 0.9 degrees), and anterior (5.2 to 9.8 mm) and posterior (3.2 to 6.7 mm) disc heights all improved significantly post-LLIF surgery (P<0.0001).
Although an effective treatment for coronal deformities and providing indirect decompression for degenerative lumbar disc disease, LLIF surgery alone is unlikely to result in correction of sagittal deformity and in particular spinopelvic harmony.
脊柱骨盆平衡（骨盆入射角[PI]=腰椎前凸[LL]±10度）的重要性在文献中已得到充分证实。我们旨在确定单纯的腰椎侧方椎间融合术（LLIF）能否成功恢复脊柱骨盆平衡，以及该手术能否维持处于平衡状态患者的这种关系。
对2012年1月至2019年8月间由同一位外科医生（AD）实施LLIF手术并随后进行后路器械融合术的患者进行回顾性影像学分析。两位作者使用Surgimap脊柱成像2.2.15.5软件对术前和术后的X线片进行评估。记录LL、PI以及PI-LL差值，以及一系列冠状面和节段性矢状面影像学参数。
共分析了71例接受LLIF治疗的患者的170个节段。术前PI-LL平均值为14.3度，术后值为13.4度（P = 0.43）。在术前失衡的41例患者中，13例（31.7%）在LLIF手术后腰椎前凸恢复到与骨盆入射角相差10度以内。30例患者术前处于脊柱骨盆平衡状态，其中25例（83.3%）在LLIF手术后维持了这种关系。平均冠状面整体Cobb角（术前13.7度，术后7.7度）、节段性冠状面Cobb角（3.8度至0.9度）以及椎间盘前缘（5.2至9.8毫米）和后缘（3.2至6.7毫米）高度在LLIF手术后均显著改善（P<0.0001）。
尽管LLIF手术是治疗冠状面畸形和为退变性腰椎间盘疾病提供间接减压的有效方法，但单纯的LLIF手术不太可能纠正矢状面畸形，尤其是脊柱骨盆平衡。
