1Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane.
2Department of Orthopaedic Surgery, University of Tsukuba.
J Neurosurg Spine. 2021 Oct 29;36(4):542-548. doi: 10.3171/2021.7.SPINE21413. Print 2022 Apr 1.
The authors sought to evaluate the relationship between the difference in lumbar lordosis (DiLL) in the preoperative supine and standing positions and spinal sagittal alignment in patients with lumbar spinal stenosis (LSS) and to determine whether this difference affects the clinical outcome of laminectomy.
Sixty patients who underwent single-level unilateral laminectomy for bilateral decompression of LSS were evaluated. Spinopelvic parameters in the supine and standing positions were measured preoperatively and at 3 months and 2 years postoperatively. DiLL between the supine and standing positions was determined as follows: DiLL = supine LL - standing LL. On the basis of this determination patients were then categorized into DiLL(+) and DiLL(-) groups. The relationship between DiLL and preoperative spinopelvic parameters was evaluated using Pearson's correlation coefficient. In addition, clinical outcomes such as visual analog scale (VAS) and Oswestry Disability Index (ODI) scores between the two groups were measured, and their relationship to DiLL was evaluated using two-group comparison and multivariate analysis.
There were 31 patients in the DiLL(+) group and 29 in the DiLL(-) group. DiLL was not associated with supine LL but was strongly correlated with standing LL and pelvic incidence (PI) - LL (PI - LL). In the preoperative spinopelvic alignment, LL and SS in the standing position were significantly smaller in the DiLL(+) group than in the DiLL(-) group, and PI - LL was significantly higher in the DiLL(+) group than in the DiLL(-) group. There was no difference in the clinical outcomes 3 months postoperatively, but low-back pain, especially in the sitting position, was significantly higher in the DiLL(+) group 2 years postoperatively. DiLL was associated with low-back pain in the sitting position, which was likely to persist in the DiLL(+) group postoperatively.
We evaluated the relationship between DiLL and spinal sagittal alignment and the influence of DiLL on postoperative outcomes in patients with LSS. DiLL was strongly correlated with PI - LL, and in the DiLL(+) group, postoperative low-back pain relapsed. DiLL can be useful as a new spinal alignment evaluation method that supports the conventional spinal sagittal alignment evaluation.
作者旨在评估腰椎管狭窄症（LSS）患者术前仰卧位与站立位腰椎前凸度（DiLL）差值与脊柱矢状位平衡的关系，并确定这种差值是否会影响减压后路椎间融合术的临床效果。
共纳入 60 例因 LSS 行单节段单侧减压后路椎间融合术的患者，术前及术后 3 个月、2 年时分别测量患者仰卧位和站立位的脊柱骨盆参数。仰卧位与站立位 DiLL 的计算方法为：DiLL=仰卧位 LL-站立位 LL。在此基础上，将患者分为 DiLL（+）组和 DiLL（-）组。采用 Pearson 相关系数评估 DiLL 与术前脊柱骨盆参数的相关性。此外，还比较了两组患者视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）评分的差异，并采用两样本比较和多元分析评估 DiLL 与临床结果的相关性。
DiLL（+）组患者 31 例，DiLL（-）组患者 29 例。DiLL 与仰卧位 LL 无相关性，与站立位 LL 和骨盆倾斜角（PI）-LL（PI-LL）呈高度正相关。在术前脊柱骨盆排列中，DiLL（+）组患者站立位时的 LL 和 SS 明显小于 DiLL（-）组，而 PI-LL 明显大于 DiLL（-）组。术后 3 个月时两组患者的临床结果无差异，但术后 2 年时 DiLL（+）组患者的下腰痛（尤其是坐位时）明显高于 DiLL（-）组。DiLL 与术后坐位下腰痛相关，在 DiLL（+）组中这种腰痛可能会持续存在。
本研究评估了 LSS 患者 DiLL 与脊柱矢状位平衡的关系，以及 DiLL 对术后结果的影响。DiLL 与 PI-LL 呈高度正相关，且在 DiLL（+）组中术后腰痛复发。DiLL 可作为一种新的脊柱排列评估方法，为传统的脊柱矢状位排列评估提供补充。
