Im Sang-Kyu, Lee Ki Young, Lim Hae Seong, Suh Dong Uk, Lee Jung-Hee
Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul 02447, Korea.
J Clin Med. 2021 Apr 26;10(9):1867. doi: 10.3390/jcm10091867.
In surgical correction of adult spinal deformity (ASD), pelvic incidence (PI)-lumbar lordosis (LL) plays a key role to restore normal sagittal alignment. Recently, it has been found that postoperative lordosis morphology act as an important factor in preventing mechanical complications. However, there have been no studies on the effect of postoperative lordosis morphology on the restoration of sagittal alignment. The primary objective of this study was to evaluate the effect of postoperative lordosis morphology on achievement of optimal sagittal alignment. The secondary objective was to find out which radiographic or morphologic parameter affects sagittal alignment in surgical correction of ASD.
228 consecutive patients with lumbar degenerative kyphosis who underwent deformity correction and long-segment fixation from T10 to S1 with sacropelvic fixation and follow-up over 2 years were enrolled. Patients were divided according to whether optimal alignment was achieved (balanced group) or not (non-balanced group) at last follow-up. We analyzed the differences of postoperative radiographic parameters and morphologic parameters between two groups. Correlation analysis and stepwise multiple linear regression analysis was performed to predict the effect of PI-LL and morphologic parameters on the sagittal vertical axis (SVA).
Of 228 patients, 195 (85.5%) achieved optimal alignment at last follow-up. Two groups significantly differed in postoperative and last follow-up LL ( < 0.001 and = 0.028, respectively) and postoperative and last follow-up PI-LL ( < 0.001 and = 0.001, respectively). Morphologic parameters did not significantly differ between the two groups except lower lordosis arc angle (=postoperative sacral slope). In correlation analysis and stepwise multiple linear regression analysis, postoperative PI-LL was the only parameter which had significant association with last follow-up SVA (R = 0.134, < 0.001). Morphologic parameters did not have any association with last follow-up SVA.
When planning spine reconstruction surgery, although considering postoperative lordosis morphology is necessary, it is still very important considering proportional lordosis correction based on individual spinopelvic alignment (PI-LL) to achieve optimal sagittal alignment.
在成人脊柱畸形（ASD）的手术矫正中，骨盆入射角（PI）-腰椎前凸（LL）对恢复正常矢状面排列起着关键作用。最近，人们发现术后前凸形态是预防机械并发症的一个重要因素。然而，关于术后前凸形态对矢状面排列恢复的影响尚无研究。本研究的主要目的是评估术后前凸形态对实现最佳矢状面排列的影响。次要目的是找出在ASD手术矫正中哪些影像学或形态学参数会影响矢状面排列。
纳入228例连续的腰椎退行性后凸患者，这些患者接受了从T10至S1的畸形矫正和长节段固定并采用骶骨盆固定，且随访时间超过2年。根据末次随访时是否实现最佳排列（平衡组）将患者分组。我们分析了两组术后影像学参数和形态学参数的差异。进行相关性分析和逐步多元线性回归分析，以预测PI-LL和形态学参数对矢状垂直轴（SVA）的影响。
228例患者中，195例（85.5%）在末次随访时实现了最佳排列。两组在术后及末次随访时的LL（分别为P<0.001和P = 0.028）以及术后及末次随访时的PI-LL（分别为P<0.001和P = 0.001）方面存在显著差异。除较低的前凸弧角度（=术后骶骨倾斜度）外，两组形态学参数无显著差异。在相关性分析和逐步多元线性回归分析中，术后PI-LL是唯一与末次随访SVA有显著相关性的参数（R = 0.134，P<0.001）。形态学参数与末次随访SVA无任何相关性。
在规划脊柱重建手术时，虽然考虑术后前凸形态是必要的，但基于个体脊柱骨盆排列（PI-LL）进行成比例的前凸矫正以实现最佳矢状面排列仍然非常重要。
