术前患者报告结局与退行性腰椎滑脱的矢状位和脊柱骨盆排列不相关。
Preoperative Patient-reported Outcomes are not Associated With Sagittal and Spinopelvic Alignment in Degenerative Lumbar Spondylolisthesis.
机构信息
Combined Neurosurgery and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
出版信息
Spine (Phila Pa 1976). 2022 Aug 15;47(16):1128-1136. doi: 10.1097/BRS.0000000000004374. Epub 2022 Apr 21.
STUDY DESIGN
Prospective cohort study.
OBJECTIVE
The aim of this study was to evaluate whether sagittal and spinopelvic alignment correlate with preoperative patient-reported outcomes (PROs) in degenerative lumbar spondylolisthesis (DLS) with spinal stenosis.
SUMMARY OF BACKGROUND DATA
Positive global sagittal balance and spinopelvic malalignment are strongly correlated with symptom severity in adult spinal deformity, but this correlation has not been evaluated in DLS.
METHODS
Patients were enrolled in the Canadian Spine Outcomes Research Network (CSORN) prospective DLS study at seven centers between January 2015 and May 2018. Correlation was assessed between the following preoperative PROs: Oswestry Disability Index (ODI), numeric rating scale (NRS) leg pain, and NRS back pain and the following preoperative sagittal radiographic parameters SS, PT, PI, SVA, LL, TK, T1SPI, T9SPI, and PI-LL. Patients were further divided into groups based on spinopelvic alignment: Group 1 PI-LL<10°; Group 2 PI-LL ≥10° with PT <30°; and Group 3 PI-LL ≥10° with PT ≥30°. Preoperative PROs were compared among these three groups and were further stratified by those with SVA <50 mm and SVA ≥50 mm.
RESULTS
A total of 320 patients (61% female) with mean age of 66.1 years were included. Mean (SD) preoperative PROs were: NRS leg pain 7.4 (2.1), NRS back pain 7.1 (2.0), and ODI 45.5 (14.5). Preoperative radiographic parameters included: SVA 27.1 (33.4) mm, LL 45.7 (13.4°), PI 57.6 (11.9), and PI-LL 11.8 (14.0°). Weak but statistically significant correlations were observed between leg pain and PT (r = -0.114) and PI (ρ = -0.130), and T9SPI with back pain ( r = 0.130). No significant differences were observed among the three groups stratified by PI-LL and PT. No significant differences in PROs were observed between patients with SVA <50 mm compared to those with SVA ≥50 mm.
CONCLUSION
Sagittal and spinopelvic malalignment do not appear to significantly influence baseline PROs in patients with DLS.
LEVEL OF EVIDENCE
Prognostic level II.
研究设计
前瞻性队列研究。
目的
本研究旨在评估退行性腰椎滑脱伴椎管狭窄患者矢状位和脊柱骨盆排列与术前患者报告结局（PROs）是否相关。
背景资料概要
在成人脊柱畸形中，阳性整体矢状位平衡和脊柱骨盆失平衡与症状严重程度密切相关，但在退行性腰椎滑脱（DLS）中尚未对此相关性进行评估。
方法
2015 年 1 月至 2018 年 5 月，7 个中心的加拿大脊柱结果研究网络（CSORN）前瞻性 DLS 研究纳入患者。评估了以下术前 PROs 与以下术前矢状位影像学参数之间的相关性：Oswestry 功能障碍指数（ODI）、数字评分量表（NRS）腿部疼痛和 NRS 背部疼痛以及 SS、PT、PI、SVA、LL、TK、T1SPI、T9SPI 和 PI-LL。患者根据脊柱骨盆排列进一步分为以下三组：组 1 PI-LL<10°；组 2 PI-LL≥10°且 PT<30°；组 3 PI-LL≥10°且 PT≥30°。比较了这三组患者的术前 PROs，并进一步根据 SVA<50mm 和 SVA≥50mm 进行分层。
结果
共纳入 320 例（61%为女性）患者，平均年龄为 66.1 岁。术前平均（SD）PROs 为：NRS 腿部疼痛 7.4（2.1），NRS 背部疼痛 7.1（2.0），ODI 45.5（14.5）。术前影像学参数包括：SVA 27.1（33.4）mm、LL 45.7（13.4°）、PI 57.6（11.9）和 PI-LL 11.8（14.0°）。腿部疼痛与 PT（r=-0.114）和 PI（ρ=-0.130）以及 T9SPI 与背部疼痛（ r=0.130）之间观察到弱但具有统计学意义的相关性。根据 PI-LL 和 PT 分层的三组之间未见显著差异。SVA<50mm 与 SVA≥50mm 的患者的 PROs 之间未见显著差异。
结论
在 DLS 患者中，矢状位和脊柱骨盆失平衡似乎不会显著影响基线 PROs。
证据水平
预后 II 级。
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